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Thoracoamniotic Shunts in Macrocystic Lung Lesions: Case Series and Review of the Literature

Authors
  • Litwińska, Magdalena
  • Litwińska, Ewelina
  • Janiak, Katarzyna
  • Piaseczna-Piotrowska, Anna
  • Gulczyńska, Ewa
  • Szaflik, Krzysztof
Type
Published Article
Journal
Fetal Diagnosis and Therapy
Publisher
S. Karger AG
Publication Date
Aug 05, 2016
Volume
41
Issue
3
Pages
179–183
Identifiers
DOI: 10.1159/000448095
PMID: 27489957
Source
Karger
Keywords
License
Green
External links

Abstract

Objective: To evaluate the efficiency of thoracoamniotic shunts for drainage of macrocystic-type congenital cystic adenomatoid malformation (CCAM). Subjects and Methods: This was a retrospective study of 12 fetuses with a large thoracic cyst treated with thoracoamniotic shunting between 2004 and 2014 in a tertiary fetal therapy center. Medline was searched to identify cases of CCAM treated with thoracoamniotic shunting. Results: In all cases the thoracic cyst was associated with major mediastinal shift, the CCAM volume ratio (CVR) was >1.6, and in eight cases there was associated hydrops. Shunt insertion was successfully carried out in all cases at a median gestational age of 24 weeks (range 18-34). In 10 cases there was live birth at a median age of 38 weeks (range 35-41), but in two hydropic fetuses there was intrauterine death. A literature search identified a total of 98 fetuses with CCAM treated with thoracoamniotic shunting between 1987 and 2016. In the combined data from the previous and the current study, the survival rate was 77% (53 of 69) for hydropic and 90% (37 of 41) for nonhydropic fetuses. Conclusions: The role of thoracoamniotic shunting in macrocystic lung lesions associated with hydrops is well accepted. Intrauterine intervention is also likely to be beneficial in the subgroup of nonhydropic fetuses with a CVR >1.6.

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