Percutaneous In Utero Thoracoamniotic Shunt Creation for Fetal Thoracic Abnormalities Leading to Nonimmune Hydrops |
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| Affiliation: | 1. Department of Radiology, Division of Vascular and Interventional Radiology, Medical College of Wisconsin, 9200 W Wisconsin Avenue, Milwaukee, WI 53226;2. Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Medical College of Wisconsin, 9200 W Wisconsin Avenue, Milwaukee, WI 53226;3. Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Aurora Baycare Medical Center Clinic, Green Bay, Wisconsin;4. Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Oregon Health and Science University, Portland, Oregon;5. Department of Obstetrics and Gynecology, Marshfield Clinic, Marshfield, Wisconsin;1. Department of Radiology, Massachusetts General Hospital;2. Division of Interventional Radiology, Massachusetts General Hospital;3. Division of Angiography and Interventional Radiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts;4. Department of Interventional Radiology, University of Texas Southwestern Medical Center, Dallas, Texas;1. Division of Vascular and Interventional Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710;2. Department of Radiology, Duke University Medical Center, Box 3808, Durham, NC 27710;1. Imaging Institute, Section of Interventional Radiology, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195;2. Department of Quantitative Health Sciences, Cleveland Clinic, 9500 Euclid Ave, Cleveland, OH 44195;1. Division of Cardiovascular Diseases, Vascular and Interventional Radiology Translational Laboratory, Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55902;2. Department of Internal Medicine, Division of Vascular and Endovascular Surgery, Vascular and Interventional Radiology Translational Laboratory, Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55902;3. Division of Vascular Interventional Radiology, Vascular and Interventional Radiology Translational Laboratory, Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55902.;1. Division of Pediatric Surgery, Department of Surgery, Taichung Veterans General Hospital, Taichung, Taiwan, ROC;2. Taichung Hospital, Ministry of Health and Welfare, Taichung, Taiwan, ROC;3. National Yang-Ming University School of Medicine, Taipei, Taiwan, ROC |
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| Abstract: | PurposeTo describe a transabdominal, transuterine Seldinger-based percutaneous approach to create a shunt for treatment of fetal thoracic abnormalities.Materials and MethodsFive fetuses presented with nonimmune fetal hydrops secondary to fetal thoracic abnormalities causing severe mass effect. Under direct ultrasound guidance, an 18-gauge needle was used to access the malformation. Through a peel-away sheath, a customized pediatric transplant 4.5-F double J ureteral stent was advanced; the leading loop was placed in the fetal thorax, and the trailing end was left outside the fetal thorax within the amniotic cavity.ResultsSeven thoracoamniotic shunts were successfully placed in five fetuses; one shunt was immediately replaced because of displacement during the procedure, and another shunt was not functioning at follow-up requiring insertion of a second shunt. All fetuses had successful decompression of the thoracic malformation, allowing lung reexpansion and resolution of hydrops. Three of five mothers had meaningful (> 7 d) prolongation of their pregnancies. All pregnancies were maintained to > 30 weeks (range, 30 weeks 1 d–37 weeks 2 d). There were no maternal complications.ConclusionsA Seldinger-based percutaneous approach to draining fetal thoracic abnormalities is feasible and can allow for prolongation of pregnancy and antenatal lung development and ultimately result in fetal survival. |
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| Keywords: | AFI" },{" #name" :" keyword" ," $" :{" id" :" key0010" }," $$" :[{" #name" :" text" ," _" :" amniotic fluid index CPAM" },{" #name" :" keyword" ," $" :{" id" :" key0020" }," $$" :[{" #name" :" text" ," _" :" congenital pulmonary airway malformation MFM" },{" #name" :" keyword" ," $" :{" id" :" key0030" }," $$" :[{" #name" :" text" ," _" :" maternal-fetal medicine |
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