Retrospective Review of Thoracoamniotic Shunting Using a Double-Basket Catheter for Fetal Chylothorax

Abstract

Objective: From a single-center retrospective cohort with fetal chylothorax, we evaluated the factors related to the decision to use shunting, poor prognostic factors, and reported shunting outcomes with a new double basket-catheter device. Methods: A retrospective single-center study was performed in 35 cases of fetal chylothorax. Results: There were 35 cases of chylothorax: 23 with hydrops and 12 without hydrops. Twenty-one procedures were performed on 15 fetuses (11 with hydrops) with a single shunt in 11, two shunts in 3 and four shunts in 1. All 12 nonhydropic cases survived. In 23 hydropic cases, overall survival rates with and without thoracoamniotic shunting were 46 and 33%, respectively. The mortality rates of fetal hydropic cases with and without ascites were 93 and 11%, respectively. Fetal ascites, progression of fetal hydrops, and premature delivery at <33 weeks were significant risk factors for a poor prognosis. Progression of polyhydramnios after shunting was also associated with a poor prognosis. Obstruction of the catheter was observed in 38%. There were no direct fetal deaths associated with shunting. Conclusion: Thoracoamniotic shunting should be considered for pleural effusion before development of fetal hydrops, or at least before the appearance of fetal ascites. A double-basket catheter tends to be obstructive, but may be less invasive for fetuses.

Thoracoamniotic shunts for the management of fetal lung lesions and pleural effusions: a single-institution review and predictors of survival in 75 cases

“…Additional factors noted to be associated with survival in the current study included GA at birth and unilateral effusions. This concurs with earlier studies which suggested these factors influence survival in the natural history of fetuses with PEs as well as those that undergo shunting [18,19,21,23]. In fetuses with large macrocystic CCAMs, we found survival significantly associated with a greater GA at birth and higher percent reduction in the size of the lung lesion following shunting.…”

“…In the current study, the overall mortality for fetuses presenting with large PEs and macrocystic CCAMs was 40% and 27% respectively. This compares favorably with mortality rates following shunt placement in these patients reported in the literature and highlights the potential of this intervention to increase survival [10,12,21,22].…”

Thoracoamniotic Shunting for Fetal Hydrothorax: Predictors of Intrauterine Course and Postnatal Outcome

“…In accordance with previous studies, the most common complications of thoracoamniotic shunting in our cohort were dislocation (range in published studies: 3.7-5.7% [5,8,9,19] ) and blockade (range in published studies: 3.7-5.7% [5,9,19] ) of the catheter with need for reintervention [12] . Another serious complication, PPROM, occurred in 10.3% (range in published studies: 5.7-33.3% [5,8,9,19] ). Similar to reports by Smith et al [3] and Yinon et al [9] , direct fetal loss upon shunt inser- 64 tion was seen in two cases with placental abruption and with hematothorax.…”

“…In previously published studies, mainly single factors have been associated with survival, such as hydrops at initial presentation [9,19] or progression of pleural effusion despite treatment [4,5,9,13,19] . We assessed a variety of factors that might influence survival and observed significantly higher amounts of polyhydramnios, hydrops placentae and mediastinal shift at initial presentation and the occurrence of PPROM in nonsurvivors.…”

“…In general, adverse prognostic factors include the presence of hydrops, lack of antenatal therapy or progress of effusion despite therapy [4][5][6][7] . The extent of effusion (unilateral vs. bilateral), polyhydramnios or gender were not significantly associated with outcome in previous studies [7,8] .…”