Ultrasound-Guided Retrieval and Position Replacement of a Dislodged Fetal Pleuro-Amniotic Shunt: A Novel Approach for a Known Complication of Feto-Amniotic Shunting

Adams, Tracy; Kunzier, Nadia B.; Chavez, Martin; Vintzileos, Anthony M.

doi:10.1159/000371576

Cited by 3 publications

(1 citation statement)

References 5 publications

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“…A new shunting device, combining the standard double pig-tail catheter with an atrial septal occluder device (AGA Medical, Plymouth, MN, USA), which is dislodgement-proof, has been developed for the in utero treatment of LUTO [ 23 ]. The retrieval and replacement of a dislodged shunt is feasible with a novel approach utilizing small grasping forceps (3 mm) under continuous ultrasound guidance [ 24 ].…”

Section: Advancements In Purpose-designed Instruments Complimentary Tmentioning

confidence: 99%

Advanced ultrasound for prenatal interventions

et al. 2018

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Ultrasound is an integral part of prenatal interventions. Doppler studies and 3-dimensional ultrasound (3DUS) are frequently used to determine whether fetal surgery is required. The operator’s experience remains crucial for reducing procedure-related morbidity. Real-time 3DUS (or 4DUS) can simultaneously display the needle tip in three orthogonal planes, providing reassurance that no fetal parts are in the path. In experienced hands, 4DUS guidance may not be more effective than B-mode, but its value for less-experienced operators remains to be determined. Recent developments in needle, shunt, and video endoscopic technologies may compliment the use of image-guided in utero procedures. Future developments of higher-dimensional transducers and image software may improve the utility of ultrasound for invasive obstetric interventions.

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Section: Advancements In Purpose-designed Instruments Complimentary Tmentioning

confidence: 99%

Advanced ultrasound for prenatal interventions

et al. 2018

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Management dilemma in Thoracoamniotic Shunt Migrations

Tan,

Wright

et al. 2023

BMJ Case Rep

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Shunt migration is a rare but significant complication of thoracoamniotic shunting, an intervention widely used for fetal pleural effusion. We describe a case of a term infant noted antenatally to have fetal hydrothorax that was managed with thoracoamniotic shunting but complicated by shunt migration. We also present the current literature on risk factors, complications and management of intrathoracic shunt migration. The majority of shunt migration cases are managed conservatively with no untoward postnatal sequelae, but surgical removal of the migrated shunt has been used for associated clinical complications, if visceral damage is suspected or if postnatal thoracic surgery is indicated for other reasons. We advocate an approach of conservative management for asymptomatic infants, where possible, to avoid unnecessary surgical and anaesthetic risks to very young, often already compromised children. However, further studies are still required to determine optimal management after shunt migration has occurred to ensure the best outcome.

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Successful in utero Percutaneous Fetoscopic Release of a Wrapped Pleuro-Amniotic Shunt around the Fetal Arm: Case Report and Review of the Literature

Nassr

Ruano²,

Espinoza

2016

Fetal Diagn Ther

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Background and Objectives: Fetal pleural effusions are either primary or secondary to chromosomal or structural fetal abnormalities. In both cases, thoraco-amniotic shunts may be indicated to prevent life-threatening consequences. In this report, we describe a rare complication of shunts and successful in utero management of this complication. We also summarize the prior reports of shunt wrapping around fetal limbs and successful prenatal release of the shunts. Data Source: Search including PubMed, MEDLINE and EMBASE databases from inception till November 2015 was conducted for cases with shunt entrapment around fetal limbs with or without prenatal management. Results: Four cases including our case have been reported in the literature with wrapping of shunts around fetal limbs. Three of these cases were successfully managed prenatally using different interventional and anesthetic techniques. Conclusions: Prenatal shunts could be rarely complicated by wrapping of the shunt around fetal limbs with possible serious vascular and neurological consequences. Different techniques have been described for prenatal management of this condition. We describe a less invasive approach that could be done under local anesthesia in suitable cases.

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Ultrasound-Guided Retrieval and Position Replacement of a Dislodged Fetal Pleuro-Amniotic Shunt: A Novel Approach for a Known Complication of Feto-Amniotic Shunting

Cited by 3 publications

References 5 publications

Advanced ultrasound for prenatal interventions

Advanced ultrasound for prenatal interventions

Management dilemma in Thoracoamniotic Shunt Migrations

Successful in utero Percutaneous Fetoscopic Release of a Wrapped Pleuro-Amniotic Shunt around the Fetal Arm: Case Report and Review of the Literature

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