Intrauterine laser ablation of a fetal cystic adenomatoid malformation with hydrops: The application of minimally invasive surgical techniques to fetal surgery

Fortunato, SJ; Lombardi, SJ; Daniell, James F.; Ismael, Silvia Cury

doi:10.1016/s0002-9378(97)80340-7

Cited by 26 publications

(15 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Maternal administration of steroids has been suggested as a possible palliative method for preventing or reversing hydrops secondary to large CPAMs; however, the survival rate using this approach remains approximately 50% [21]. Percutaneous laser ablation of solid CPAMs have also had mixed results, including worsening hydrops and intrauterine fetal demise [22,23]. However, one series that showed promise examined the novel use of percutaneous sclerotherapy for the treatment of type II and III CPAMs [14].…”

Section: Discussionmentioning

confidence: 99%

Treatment of Congenital Pulmonary Airway Malformation Induced Hydrops Fetalis via Percutaneous Sclerotherapy

et al. 2012

View full text Add to dashboard Cite

Large type II and III congenital pulmonary airway malformations (CPAMs) can cause pulmonary hypoplasia, non-immune hydrops fetalis and fetal demise. Fetal intervention is indicated if hydrops fetalis develops. In this report, we describe three cases of type II and III CPAMs complicated by hydrops and treated with percutaneous sclerotherapy by ethanolamine injection into the tumor. All 3 cases demonstrated reduction in size of the CPAM and resolution of the hydrops with subsequent delivery at term. We believe that fetal percutaneous sclerotherapy can be used as a minimally invasive palliative strategy to treat CPAM-induced hydrops fetalis. Further studies are needed to delineate the risks of this novel technique.

show abstract

Section: Discussionmentioning

confidence: 99%

Treatment of Congenital Pulmonary Airway Malformation Induced Hydrops Fetalis via Percutaneous Sclerotherapy

et al. 2012

View full text Add to dashboard Cite

show abstract

“…In each case, the foetus was hydropic, the lesion was microcystic and occupied more than half of the chest cavity [6][7][8] .…”

Section: Discussionmentioning

confidence: 99%

“…Fortunato et al [8] fi rst reported on the use of laser in 1997. This report was presented at a scientifi c meeting and published as an abstract.…”

Section: Discussionmentioning

confidence: 99%

“…Unlike two other reports that used foetoscopy [6,8] , with an approximately 5% risk of amniorrhexis, we used percutaneous needle placement into the foetal tumour to direct the 400 m laserfi bre.…”

Section: Discussionmentioning

confidence: 99%

“…A possible alternative to these options is percutaneous siting of an intrauterine laser fi bre with ablation. To date, there have been three reported cases where laser ablation has been attempted [6][7][8] .Two cases were associated with foetal or neonatal demise [6,7] . In one case [8] , a successful outcome was never formally reported.…”

mentioning

confidence: 99%

See 2 more Smart Citations

Laser Ablation of Foetal Microcystic Lung Lesion: Successful Outcome and Rationale for Its Use

et al. 2006

View full text Add to dashboard Cite

Objective: A foetus with an echodense, microcystic lung lesion complicated by non-immune hydrops has a high mortality rate. Because of the limited treatment options available, laser ablation was offered in an attempt to reduce the size of the lesion and reduce hydrops fetalis. Methods and Results: A 25-year-old nulliparous woman presented at 21 weeks gestation. Ultrasound revealed a male foetus with a large microcystic right sided lung lesion that completely occupied the right hemithorax causing marked mediastinal deviation. The foetus was hydropic with polyhydramnios. Percutaneous laser ablation of the large microcystic lung lesion was performed under direct ultrasound control. At a power setting of 45 W, and using a 400 µm Nd:YAG laser fibre, the core of the lesion was photocoagulated in pulses lasting 5 s at 5 s intervals. The total target dose was 1683 J. This led to a marked but temporary reduction in amniotic fluid volume. The patient was commenced on sulindac and amniodrainage was performed at 27 weeks as reaccumulation of the polyhydramnios occurred. Pre-eclampsia complicated the pregnancy at 38 weeks gestation and an emergency caesarean section was performed. The baby underwent a thoracotomy and lobectomy at 48 h of age, made a good recovery, and is currently well 8 weeks post-delivery. Conclusions: In cases of cystic lung lesion complicated by hydrops, laser ablation should be considered as a treatment option.

show abstract

In utero therapy for fetal thoracic abnormalities

Wilson

2008

Prenatal Diagnosis

View full text Add to dashboard Cite

Fetal thoracic lung anomalies are rare. The specific diagnosis can be made by utilizing ultrasound, magnetic resonance imaging (MRI), and Doppler studies. Perinatal surveillance is required for large lesions and mediastinal shift regardless of the pathological diagnosis. These can cause physiological changes in the cardiovascular system with resulting hydrops. In utero therapies are variable but with no large randomized trials to compare risks and benefits. In most cases of fetal lung lesions, continued observation with postnatal therapy is the outcome. When fetal hydrops is present or impending, in utero fetal therapy is required to try to reverse that pathological course associated with fetal or neonatal death. Maternal morbidity is increased with the development of MIRROR syndrome following the presence of long-standing fetal hydrops and possible surgical procedures.

show abstract

Intrauterine laser ablation of a fetal cystic adenomatoid malformation with hydrops: The application of minimally invasive surgical techniques to fetal surgery

Cited by 26 publications

References 0 publications

Treatment of Congenital Pulmonary Airway Malformation Induced Hydrops Fetalis via Percutaneous Sclerotherapy

Treatment of Congenital Pulmonary Airway Malformation Induced Hydrops Fetalis via Percutaneous Sclerotherapy

Laser Ablation of Foetal Microcystic Lung Lesion: Successful Outcome and Rationale for Its Use

In utero therapy for fetal thoracic abnormalities

Contact Info

Product

Resources

About