Outcome of Bronchopulmonary Sequestration with Massive Pleural Effusion after Intrafetal Vascular Laser Ablation

Abstract

Objective: To assess the outcome of 12 fetuses with bronchopulmonary sequestration (BPS) and massive pleural effusion after intrafetal vascular laser ablation (VLA). Methods: All fetuses with BPS and massive pleural effusion that were treated with intrafetal VLA during a 5-year period (2012-2016) were reviewed for safety, intrauterine course, and postnatal outcome. Results: In the study period, 12 fetuses with BPS were treated with VLA. In 7 (58.3%) fetuses, complete cessation of blood flow was achieved after the first VLA, while in 5 (41.7%) fetuses, residual perfusion of the feeding vessel was demonstrated at follow-up. A second intervention was successful in 4 of 5 (80%) fetuses. Overall, in 11 of 12 (91.7%) fetuses, complete coagulation of the feeding vessel could be achieved, followed by a reduction in size or complete resolution of the BPS. All 11 fetuses with successful prenatal intervention were live-born at a median gestational age of 39⁺¹ (range, 37⁺⁵-41⁺²) weeks. Postnatally, 2 (18.2%) of the 11 newborns underwent sequestrectomy, as well as the preterm newborn on which a second fetal intervention was not feasible. Conclusion: VLA is an effective and safe treatment of BPS that appears to be of benefit in improving prognosis and decreasing the need for postnatal sequestrectomy.

Imaging of fetal tumors and other dysplastic lesions: A review with emphasis on MR imaging

“…Other manners of prenatal treatment of sequestrations have been proposed by others, including the occlusion of the feeding vessel by ultrasound‐guided laser, radiofrequency ablation, and thrombogenic coil embolization, with mixed results.…”

Intrauterine Ultrasound-Guided Laser Coagulation as a First Step for Treatment of Prenatally Complicated Bronchopulmonary Sequestration: Our Experience and Literature Review

“…However, in all these cases, the reported indication for the second procedure was the reappearance of blood flow in the feeding artery and it was not specified whether the hydrothorax had recurred. 20 Since fetal surgery is still associated to potential severe complications, 23,24 we believe that a repeat procedure should be indicated only in those cases in which recurrence of pleural effusion is noted in addiction to reperfusion of the mass. Cases in which blood flow in the feeding artery has recurred without signs of fetal hemodynamic compromise should be treated, in our opinion, as noncomplicated BPS in which the definitive treatment can be safely performed postnatally.…”

“…Review of the literature identified 11 studies with original data of at least one case of BPS treated prenatally with USLC. 2,[12][13][14][15][16][17][18][19][20][21][22] Data on a total of 57 patients, including the five cases reported in the present series, were extrapolated and analyzed.…”

Antenatal Management of Bronchopulmonary Sequestration by Intrafetal Vascular Laser Ablation under Ultrasound Control: Narrative Review of the Literature and Report of Three Cases

“…Two complications were reported. First, fetal thoracic hematoma leading to fetal anemia complicated the procedure performed at 34 WG [15]. The fetus required postoperative blood transfusion.…”