Percutaneous Laser Ablation of Fetal Congenital Cystic Adenomatoid Malformation: Too Little, Too Late?

Bruner, Joseph P.; Jarnagin, B.; Reinisch, Lou

doi:10.1159/000021037

Cited by 54 publications

(38 citation statements)

References 10 publications

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“…Other PE techniques reported include singleneedle aspiration [29], pleurodesis with OK-432 [30,31], maternal diet [32], intrapartum drainage [33], and shunting in a twin gestation [34]. Bruner et al [35] used percutaneous laser ablation on a microcystic CCAM at 23 weeks of gestation, and, although the tumor size decreased, there was worsening of the hydrops, and fetal death occurred. Spontaneous resolution of nonimmune hydrops with CCAM has been reported, but spontaneous resolution without therapy is rare [36].…”

Section: Discussionmentioning

confidence: 99%

Thoracoamniotic Shunts: Fetal Treatment of Pleural Effusions and Congenital Cystic Adenomatoid Malformations

et al. 2004

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Objective: To determine whether fetuses that underwent thoracoamniotic shunt placement for treatment of pleural effusion (PE) or macrocystic congenital cystic adenomatoid malformation (CCAM) have an improved outcome as compared with an untreated population. Methods: A retrospective review from a single tertiary center was performed using thoracoamniotic shunt placement to treat PE or macrocystic CCAM between 1998 and 2001. Thoracoamniotic shunts were used on 26 occasions in 19 pregnancies. Results: The average gestational age at the diagnosis of PE and CCAM was 22 + 4 and 20 + 0 weeks, respectively. Shunts were offered in pregnancies complicated by hydrops or at significant risk for pulmonary hypoplasia. Shunts were placed at 26 + 2 weeks (average) and 23 + 1 weeks (average) in the PE and CCAM groups, respectively. In CCAM patients, the mean pre- and postshunting mass volumes were 50.5 and 25.7 cm³, representing a 51% reduction in mass volume following shunt placement. In the PE group, the average delivery age was 33 + 5 weeks, with an average shunt placement to delivery time of 7 + 3 weeks. In the CCAM group, the average delivery was 33 + 3 weeks, with an average shunt placement to delivery time of 10 + 2 weeks. The postnatal survival rates were 67% (6/9) and 70% (7/10) in the PE and CCAM groups, respectively. Conclusions: (1) Thoracoamniotic shunts should be considered as a treatment option for selected PE or macrocystic CCAM fetuses with hydrops or a significant risk for pulmonary hypoplasia; (2) the neonatal survival with shunting was similar for PE and CCAM groups and was improved as compared with literature reports, and (3) fetuses with CCAM presented earlier with hydrops than those with PE. Successful shunting resulted in a prolongation of pregnancy into the 3rd trimester in both groups.

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Section: Discussionmentioning

confidence: 99%

Thoracoamniotic Shunts: Fetal Treatment of Pleural Effusions and Congenital Cystic Adenomatoid Malformations

et al. 2004

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“…Open fetal surgery with intrauterine resection of the enlarged pulmonary lobe (lobectomy) is being offered with an overall survival rate of 50% but with high maternal and fetal risks; therefore, it has now been almost abandoned [13]. Regarding minimally invasive fetal surgery, percutaneous laser ablation of the lung mass has been attempted with disappointing results [14]. In 2 previous reports, during percutaneous sclerotherapy ethanolamine or polidocanol was injected into the lung mass of 6 fetuses with CCAM and hydrops, including 2 cases with solid microcystic CCAM (type III) [15,16].…”

Section: Discussionmentioning

confidence: 99%

Fetal Bronchoscopy as a Useful Procedure in a Case with Prenatal Diagnosis of Congenital Microcystic Adenomatoid Malformation

Cruz‐Martínez¹,

Méndez²,

Perez-Garcilita³

et al. 2014

Fetal Diagn Ther

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Massive microcystic congenital cystic adenomatoid malformation (CCAM) and bronchial atresia are associated with a high perinatal mortality secondary to lung hypoplasia and cardiac dysfunction, and fetal intervention should be considered to improve prognosis. Therapeutic options include open fetal surgery with pulmonary resection, fetal sclerotherapy and fetoscopy. We present a case with a severely enlarged left lung without ultrasound signs of dilated airways compatible with the diagnosis of microcystic CCAM, hydrops and severe contralateral lung hypoplasia that was treated successfully at 30 weeks of gestation by fetal bronchoscopy, through which bronchial atresia was identified at the end of the left mainstem bronchi and permeabilized by laser ablation. After fetal surgery, weekly follow-up showed a progressive decrease in the affected lung size and an increase in the contralateral hypoplastic lung size, demonstrating normal dimensions of both lungs at 34 weeks of gestation, reversal of the mediastinal shift, and complete disappearance of hydrops. A healthy neonate was delivered uneventfully at term with no need for respiratory support, and the boy is now doing well at 15 months of age. This report demonstrates that in cases with prenatal diagnosis of large microcystic CCAM, fetal bronchoscopy can be used to refine the diagnosis of bronchial atresia and as a therapeutic tool with good outcome.

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“…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

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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.

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Percutaneous Laser Ablation of Fetal Congenital Cystic Adenomatoid Malformation: Too Little, Too Late?

Cited by 54 publications

References 10 publications

Thoracoamniotic Shunts: Fetal Treatment of Pleural Effusions and Congenital Cystic Adenomatoid Malformations

Thoracoamniotic Shunts: Fetal Treatment of Pleural Effusions and Congenital Cystic Adenomatoid Malformations

Fetal Bronchoscopy as a Useful Procedure in a Case with Prenatal Diagnosis of Congenital Microcystic Adenomatoid Malformation

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

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