Thoraco-Amniotic Shunting

Nicolaides, Kypros H.; Azar, Ghassan

doi:10.1159/000263586

Cited by 124 publications

(113 citation statements)

References 21 publications

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“…Several authors have reported on the performance of thoracocentesis or thoracoamniotic shunting 2,14,15 . In the largest series of 47 cases of pleural effusion, the overall survival was 100% if no ascites or edema were present but only 50% in the presence of hydrops 5 . Fetal pleural effusion is also associated with an increased risk of the development of polyhydramnios and preterm labor.…”

Section: Discussionmentioning

confidence: 95%

“…There are several methods of treatment for a pleural effusion before 32 weeks of gestation, including thoracoamniotic shunting and repeated thoracocentesis 5 . However, a review of all reported cases of thoracoamniotic shunting for fetal hydrothorax showed a survival rate of 65% (38 / 59 fetuses) 3 so the mortality was very high despite this intervention.…”

Section: Discussionmentioning

confidence: 99%

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A new fetal therapy for chylothorax: pleurodesis with OK‐432

Okawa

Takano

Fujimori

et al. 2001

Ultrasound in Obstet & Gyne

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Section: Discussionmentioning

confidence: 95%

Section: Discussionmentioning

confidence: 99%

A new fetal therapy for chylothorax: pleurodesis with OK‐432

Okawa

Takano

Fujimori

et al. 2001

Ultrasound in Obstet & Gyne

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“…1,9,10 While uncommon, antenatal diagnosis and treatment by thoracoaminiocentesis have also been reported. 11,12 Bronchogenic cysts often seem to have check valves that lead to their progressive enlargement. Such enlargement produces symptoms of air compression, which is most common in neonates and young infants, although it does happen occasionally later in life.…”

Section: Discussionmentioning

confidence: 99%

Bronchogenic Cyst and Its Progress in a Premature Infant

et al. 1999

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The progressive course of a congenital bronchogenic cyst in a very low birth weight infant with respiratory distress is presented. A bronchogenic cyst, while uncommon, should be in the differential diagnosis of pneumomediastinum or medial pneumothorax even in premature infants who are on ventilators.Bronchogenic cysts are an uncommon congenital malformation of the airway with the potential for serious morbidity or mortality. There have been no previous reports of bronchogenic cysts in premature infants. Two reviews of bronchogenic cysts over a 30-year period do not mention their presence or progression.1,2 We report a case of bronchogenic cyst in a very small preterm infant and its gradual progress as shown by chest radiography. CASE REPORTWB was a 25-week gestation, 625-gm infant, born to a 26-year-old multigravida mother. Maternal history was significant for a positive tuberculin test, negative chest radiograph for infiltrates suggestive of tuberculosis, and a history of cocaine abuse. Apgar scores were 1, 5, and 6 at 1, 5, and 10 minutes, respectively. The infant was intubated in the delivery room secondary to his prematurity. He received surfactant at 1, 12, and 24 hours of life. The chest radiograph results were consistent with respiratory distress syndrome, which improved by day 3 of life ( Figure 1). On day 4 of life, a mediastinal air shadow was observed on a routine chest radiograph (Figure 2). The infant also demonstrated persistent metabolic acidosis with increasing ventilatory requirements. Based on clinical presentation, a patent ductus arteriosus was suspected. The next day, a routine radiograph of the chest showed the previously described air shadow, which was slightly increased in size.The patent ductus arteriosus was treated with three doses of indomethacin. Echocardiography obtained after treatment of the patent ductus arteriosus showed a cystic structure behind the left and right atria. A barium esophagram was performed that ruled out esophageal cyst and duplication. Despite low settings on the mechanical ventilator, the air shadow showed a progressive increase in size and a diagnosis of bronchogenic cyst was entertained (Figure 3). Cardiothoracic surgery was consulted and elective surgery was planned for the next day as the infant was stable on the ventilator with pressures of 16/5 mm Hg peak inspiratory rate (PIP/peak end-expiratory pressure), ventilatory rate of 28, and FIO 2 of 0.30. On the same night, the infant started having frequent episodes of oxygen desaturation, and a chest radiograph showed the development of a left-sided pneumothorax. A repeat radiograph obtained after inserting a chest tube showed a me-

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“…Percutaneous in utero pleuroamniotic shunt is indicated for severe or recurrent chylothorax compromising the fetal lung development and to prevent cardiac failure. Survival past the neonatal period (period not defined in all studies) following the insertion of a pleuroamniotic shunt to drain the pleural effusion has been reported to be between 47% and 70%, [48][49][50][51][52][53] although the severity of effusion and underlying pathology may vary between studies. A German case series of 78 fetuses with hydrothorax treated with pleuroamniotic shunt showed that polyhydramnios, hydrops placentae, shunt-birth interval <4 weeks, and low gestational at birth were associated with mortality.…”

Section: 25mentioning

confidence: 99%

“…53 Dislodgement of the shunt into the fetal chest may occur due to growing chest size, fetal movements, or improper placement of the device and can occur in 23% of cases. 54 Case series have shown that reinsertion of shunt was required in 6-8%, 49,50 and fetal loss was around 10%. 48 OK-432 (Picibanil) is a lyophilized preparation of a low-virulence strain of group A Streptococcus pyogenes of human origin, which is used as a sclerosing agent.…”

Section: 25mentioning

confidence: 99%

Congenital chylothorax: current perspectives and trends

Krishnamurthy

Malhotra

2017

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Congenital chylothorax (CC) is the most common cause of pleural effusion in the perinatal period. The etiology is unknown in the majority of the cases. However, in some cases, it can be associated with various syndromes and genetic conditions. CC is associated with a high mortality rate. Most of the clinical manifestations are secondary to pressure effects (pulmonary hypoplasia) and loss of protein and lymphatic fluid (hydrops, malnutrition). Conservative management in the neonatal period is effective in up to 80% of cases and includes pleural drainage, parenteral nutrition/enteral medium-chain triglyceride-based formulae, and medications such as octreotide. Surgical intervention (pleurodesis, thoracic duct ligation/embolization, pleuroperitoneal shunt) may be required in persistent cases. A universal consensus on management of CC is unavailable, and data on the safety of medication use for CC in neonates are sparse.

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Thoraco-Amniotic Shunting

Cited by 124 publications

References 21 publications

A new fetal therapy for chylothorax: pleurodesis with OK‐432

A new fetal therapy for chylothorax: pleurodesis with OK‐432

Bronchogenic Cyst and Its Progress in a Premature Infant

Congenital chylothorax: current perspectives and trends

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