Thoracoscopic Removal of Retained Thoracoamniotic Shunt Catheters in Newborns

Macchini, Francesco; Gentilino, Valerio; Morandi, Anna; Leva, Ernesto

doi:10.1089/lap.2014.0133

Cited by 9 publications

(13 citation statements)

References 13 publications

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“…Shunt dislodgment has been reported previously, including extrathoracic [6, 12, 23, 32], and intrath intrathoracic migration [6, 12, 18, 23-25, 30, 32, 33], with 1 reported neonatal death related to intrathoracic migration and hilar vessel strangulation [34] and 1 case of migration through the myometrium into the maternal peritoneal cavity [35]. Generally, extra-thoracic migration of shunts into the amniotic cavity poses less clinical concern and can usually be retrieved at the time of delivery.…”

Section: Discussionmentioning

confidence: 99%

“…In another report of 2 hydropic fetuses with bilateral chest shunts inserted at 27 weeks, uncomplicated thoracoscopic removal of the internally migrated shunts was performed on the 5th and 14th days of life, respectively, due to their mediastinal location. Specifically, they were located in the right paracardiac region, between the right upper and middle lobes, and left paravertebral region, adjacent to the intrathoracic aorta [33]. In another prospective multicenter series from Japan, 4 double-basket shunts among 42 fetal shunt procedures migrated into the thorax, and all were retrieved postnatally.…”

Section: Discussionmentioning

confidence: 99%

“…Based on the published literature, some authors have recommended a conservative approach in the management of intrathoracic fetal chest shunts, due to the inert nature of the shunt material [18], while others have suggested early elective removal to avoid potential risks of fibrous or inflammatory change, which might complicate shunt removal [25, 33], or due to the shunt’s proximity to mediastinal structures [33, 34], infection risk, or potential impact on future adhesion therapy [25]. To the best of our knowledge, this is the largest series evaluating complications that may occur with shunt dislodgment, particularly intrathoracic migration, and any relevant contributing procedural factors.…”

Section: Discussionmentioning

confidence: 99%

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Perinatal Outcome in Fetuses with Dislodged Thoraco-Amniotic Shunts

et al. 2021

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Objective: Fetal thoraco-amniotic shunts (TASs) can dislodge in utero, migrating internally into the fetal thorax or externally into the amniotic cavity. Our objective was to evaluate the perinatal and long-term outcome of fetuses with TAS dislodgement and conduct a review of the literature. Methods: This is a retrospective review of all TAS inserted for primary pleural effusions and macrocystic congenital pulmonary airway malformations (CPAMs) in a tertiary fetal medicine center (1991–2020). Antenatal history, procedural factors, and perinatal and long-term outcomes were reviewed in all fetuses with dislodged shunts and compared to fetuses with shunts that did not dislodge. Results: Of 211 TAS inserted at a mean gestational age of 27.8 weeks ± 5.47 (17.4–38.1 weeks), 187 (89%) were inserted for pleural effusions and 24 (11%) for macrocystic CPAMs. Shunts dislodged in 18 fetuses (8.5%), 17 (94%) of which were for pleural effusions. Shunts migrated into the chest wall/amniotic cavity or into the thorax among 7/18 (39%) and 11/18 (61%) fetuses, respectively. Eleven (61%) fetuses were initially hydropic, which resolved in 8 (72%) cases. Effusions were bilateral in 9 (50%), amnioreduction was required in 6 (33%), and fetal rotation in 8 cases (44%). Four (22%) fetuses underwent repeat shunting, 12 (67%) neonates required ventilatory support, and 2 (11%) neonates required chest tubes. There was no significant difference in technical factors or outcomes between infants with shunts that dislodged and those that did not. Among 11 intrathoracic shunts, 2 (18%) were removed postnatally and the remainder are in situ without any shunt-related or respiratory complications over a follow-up period of 9 months to 22 years. Conclusion: TAS dislodged antenatally in 8.5% of fetuses, with 2/3 of shunts migrating into the thorax, and nearly 25% requiring re-shunting. Retained intrathoracic shunts were well tolerated and may not necessarily require surgical removal after birth.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Perinatal Outcome in Fetuses with Dislodged Thoraco-Amniotic Shunts

et al. 2021

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“…Yet, the ideal management and timing of intervention for a displaced thoracoamniotic shunt is not well documented due to its rarity. Only sporadic cases of thoracoscopic removal of a retained shunt were reported (10,11). In the case series reported by the Japan group, the procedures were done several days after birth for stabilization of the respiratory status of the newborns.…”

Section: Discussionmentioning

confidence: 99%

Thoracoscopic removal of a displaced thoracoamniotic shunt in a newborn with antenatal pleural effusion—a case report

et al. 2020

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Thoracoamniotic shunt has been considered as a treatment for antenatal pleural effusion and complication is rare. In majority of cases, the shunt can be removed uneventfully. In this article, we reported a rare complication of shunt migration resulting in the need of thoracoscopic removal at newborn period.The patient born at 39+3 weeks of gestation suffered from antenatal chylothorax detected at 28 weeks and was managed by intrauterine thoracoamniotic shunt insertion. This was complicated by shunt displacement, which caused respiratory distress after birth requiring ventilatory support and progressive pleural effusion in this patient. To prevent further neonatal compromise, thoracoscopic removal of the retained shunt was done on day 7 of life followed by post-op chest drain insertion. Post-op condition was stable with resolution of respiratory distress, and the patient was discharge on post-op day 16. We would like to remind clinicians about this potential complication of thoracoamniotic shunt, which can pose a potential risk of severe neonatal compromise, and that it can be managed by minimal invasive surgery even in the newborn period.

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“… 5 Thoracoamniotic shunt positioning could theoretically avoid the need for multiple thoracentesis; however, reaccumulation of fluid was reported by Cavoretto et al in 2 out of 17 reviewed cases, 11 and thoracoamniotic shunts may dislocate with possible increased morbidity. 19 A survival rate of 92% is reported by Witlox et al 5 after thoracoamniotic shunting for PS. The laser ablation and the sclerotherapy of the feeding vessel have the aim of reducing the blood sequestration from fetal circulation and the PS mass itself, thus treating the disease and reversing its complications.…”

Section: Introductionmentioning

confidence: 93%

Combined Pre- and Postnatal Minimally Invasive Approach to Complicated Pulmonary Sequestrations

Ichino

Macchini

Morandi

et al. 2020

European J Pediatr Surg Rep

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Pulmonary sequestration (PS) is mostly asymptomatic but there is a proportion of fetuses that develop hydrops, leading to fetal or neonatal death. Fetal treatments are available, but postnatal management of the residual lesions is not uniformly defined. We present two cases of combined pre- and postnatal minimally invasive approach to complicated extra-lobar PS.Patient 1 presented with complicated PS at 31 weeks of gestation. Ultrasound-guided laser coagulation of the anomalous artery was successful. The patient was born asymptomatic at 38 weeks. Neonatal magnetic resonance imaging (MRI) showed a residual mass, confirmed by computed tomography (CT) at 6 months. No systemic artery was described, but perfusion was present. We decided for thoracoscopic resection. A residual artery was identified and sealed. Patient 2 presented with complicated PS at 25 weeks of gestation, underwent laser coagulation of the anomalous artery and was born asymptomatic at 38 weeks. Neonatal MRI showed persistence of the lesion, confirmed by CT scan at 4 months. We proceeded with thoracoscopic resection. A residual vessel was ligated. The patients 1 and 2 are now 24 and 21 months old, respectively, and healthy.Prenatal treatment of complicated PS is a life-saving procedure.Postnatal thoracoscopic resection of the residual lesion is feasible and safe; we believe it is the best course of treatment to grant the complete excision of the malformation.

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Thoracoscopic Removal of Retained Thoracoamniotic Shunt Catheters in Newborns

Cited by 9 publications

References 13 publications

Perinatal Outcome in Fetuses with Dislodged Thoraco-Amniotic Shunts

Perinatal Outcome in Fetuses with Dislodged Thoraco-Amniotic Shunts

Thoracoscopic removal of a displaced thoracoamniotic shunt in a newborn with antenatal pleural effusion—a case report

Combined Pre- and Postnatal Minimally Invasive Approach to Complicated Pulmonary Sequestrations

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