Fetal laryngoscopy to evaluate vocal folds in a fetus with congenital high airway obstruction syndrome (CHAOS)

Ruano, Rodrigo; Cass, Darrell L.; Rieger, Michael; Javadian, Pouya; Shamshirsaz, Alireza A.; Belfort, Michael A.

doi:10.1002/uog.13191

Cited by 14 publications

(15 citation statements)

References 12 publications

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“…However, it has been demonstrated that in experienced hands, fetal tracheoscopy for the treatment of fetuses with congenital diaphragmatic hernia can be achieved in a median surgical time of 10 min [15]. Similarly, we and others have demonstrated the feasibility of fetal airway endoscopy for cases with congenital high airway obstruction syndrome [16,17], bronchial atresia [18] and congenital microcystic adenomatoid malformation [19,20]. In this regard, it would be expected that fetal tracheoscopy in cases with neck masses may be more challenging due to severe distortion of the glottis, laryngeal and tracheal anatomy.…”

Section: Discussionmentioning

confidence: 99%

Fetal Endoscopic Tracheal Intubation: A New Fetoscopic Procedure to Ensure Extrauterine Tracheal Permeability in a Case with Congenital Cervical Teratoma

Cruz‐Martínez

Moreno-Álvarez²,

Garcia³

et al. 2014

Fetal Diagn Ther

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Congenital neck masses are associated with high perinatal mortality and morbidity secondary to airway obstruction due to a mass effect of the tumor with subsequent neonatal asphyxia and/or neonatal death. Currently, the only technique designed to establish a secure neonatal airway is the ex utero intrapartum treatment (EXIT) procedure, which involves neonatal tracheal intubation while fetal oxygenation is maintained by the uteroplacental circulation in a partial fetal delivery under maternal general anesthesia. We present a case with a giant cervical teratoma and huge displacement and compression of the fetal trachea that was treated successfully at 35 weeks of gestation with a novel fetoscopic procedure to ensure extrauterine tracheal permeability by means of a fetal endoscopic tracheal intubation (FETI) before delivery. The procedure consisted of a percutaneous fetal tracheoscopy under maternal epidural anesthesia using an 11-Fr exchange catheter covering the fetoscope that allowed a conduit to introduce a 3.0-mm intrauterine orotracheal cannula under ultrasound guidance. After FETI, a conventional cesarean section was performed uneventfully with no need for an EXIT procedure. This report is the first to illustrate that in cases with large neck tumors involving fetal airways, FETI is feasible and could potentially replace an EXIT procedure by allowing prenatal airway control.

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Section: Discussionmentioning

confidence: 99%

Fetal Endoscopic Tracheal Intubation: A New Fetoscopic Procedure to Ensure Extrauterine Tracheal Permeability in a Case with Congenital Cervical Teratoma

Cruz‐Martínez

Moreno-Álvarez²,

Garcia³

et al. 2014

Fetal Diagn Ther

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“…Identification of the level of airway obstruction is important in choosing between fetal or neonatal interventions, and the observations described by us can provide a reliable alternative to MRI in the prediction of level and extent of airway obstruction. Fetoscopy/fetal laryngoscopy have also been used to evaluate the suitability for surgery …”

Section: Discussionmentioning

confidence: 99%

“…Fetoscopy/fetal laryngoscopy have also been used to evaluate the suitability for surgery. 1,11,12 Congenital high airway obstruction syndrome is most often misdiagnosed as bilateral CCAM. Congenital cystic adenomatoid malformations are generally unilateral lesions; however, type III CCAM can have bilateral, uniform, hyperechoic appearance of the lungs on sonography.…”

Section: Discussionmentioning

confidence: 99%

Locating the Level and Extent of Congenital High Airway Obstruction: Fluid in the Airway Tract as Reference Points

Gowda

Gupta

Ali

et al. 2017

J of Ultrasound Medicine

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Described here are a series of four cases of congenital high airway obstruction in the fetus. All of the patients presented in the second trimester and all had hydrops fetalis. Three cases had bilateral hyperinflated lungs, midline shift of heart, flattening or inversion of the diaphragm, and fetal ascites. Autopsy was performed in one of these three and showed laryngeal atresia. In one fetus, there was only a unilateral huge enlargement of the lung with mediastinal shift. On autopsy, this fetus had atresia of right main bronchus. All parents had terminated the pregnancy following the prenatal diagnosis. Laryngeal atresia is an extremely rare fetal anomaly with dismal prognosis. It is important to differentiate the condition from other lesions with a more favorable prognosis, such as congenital adenomatoid malformation of the lung. Much research is needed in the future to explore the therapeutic options, including fetoscopic intervention or transplantation of stem cell-derived airways.

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“…Normal trachea and vocal cords could be observed, and just below a bulging tissue occluding the tracheal lumen was observed and removed using a diode laser fiber at a power setting of 10 W. This was the first case of a long-term intact survival after fetoscopic airway deobstruction. However, according to Ruano et al [7], fetal ultrasound and MRI are limited in their ability to define the involvement of the vocal cords and the complexity of the obstruction. Therefore, under specific circumstances and after thorough consideration by the patient and the medical team, fetal tracheoscopy could be a valuable option as a diagnostic tool as well as a therapeutic one.…”

Section: Discussionmentioning

confidence: 99%

Treatment of a Fetal Tracheal Obstruction by Fetoscopy and Laser

Bel¹,

Sananès²,

Gaudineau³

et al. 2015

Fetal Diagn Ther

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We report below a case of in utero tracheoscopy with laser collapse of a bronchogenic cyst obstructing the fetal trachea. The patient was referred for ultrasonography at 24 weeks of gestation because of fetal hydrops. Tracheoscopy was performed via fetoscopic approach using a single trocar under local anesthesia with lidocaine and ultrasound guidance. This revealed an image suggestive of a cyst obstructing the middle third at the anterior base of the trachea. Coagulation using a diode laser enabled us to collapse this fluid-filled cyst with three 10-watt bursts (3 times 3 s) and to visualize a completely unobstructed tracheobronchial tree with significant pulmonary fluid reflux on removal of the obstacle. The fetal condition improved markedly within 48 h after the procedure. To the best of our knowledge, this is the first described case of in utero treatment of a tracheal obstruction by tracheoscopy and laser. In severe cases of obstruction of the fetal airways, whether the obstacle is situated in a high or low position, fetal endoscopy is of diagnostic and potentially therapeutic utility.

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Fetal laryngoscopy to evaluate vocal folds in a fetus with congenital high airway obstruction syndrome (CHAOS)

Cited by 14 publications

References 12 publications

Fetal Endoscopic Tracheal Intubation: A New Fetoscopic Procedure to Ensure Extrauterine Tracheal Permeability in a Case with Congenital Cervical Teratoma

Fetal Endoscopic Tracheal Intubation: A New Fetoscopic Procedure to Ensure Extrauterine Tracheal Permeability in a Case with Congenital Cervical Teratoma

Locating the Level and Extent of Congenital High Airway Obstruction: Fluid in the Airway Tract as Reference Points

Treatment of a Fetal Tracheal Obstruction by Fetoscopy and Laser

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