Faculty Collaboration Database

Percutaneous in utero thoracoamniotic shunt creation for fetal thoracic abnormalities leading to nonimmune hydrops. J Vasc Interv Radiol 2014 Jun;25(6):889-94

Date

04/08/2014

Pubmed ID

24702750

Pubmed Central ID

PMC4671206

DOI

10.1016/j.jvir.2014.02.009

Scopus ID

2-s2.0-84901617865 (requires institutional sign-in at Scopus site)   4 Citations

Abstract

PURPOSE: To describe a transabdominal, transuterine Seldinger-based percutaneous approach to create a shunt for treatment of fetal thoracic abnormalities.

MATERIALS AND METHODS: Five 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.

RESULTS: Seven 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.

CONCLUSIONS: A 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.

Author List

White SB, Tutton SM, Rilling WS, Kuhlmann RS, Peterson EL, Wigton TR, Ames MB

Authors

Erika Peterson MD Professor in the Obstetrics and Gynecology department at Medical College of Wisconsin
William S. Rilling MD, FSIR Vice Chair, Professor in the Radiology department at Medical College of Wisconsin
Sarah B. White MD, MS, FSIR, FCIRSE Associate Dean, Vice Chair, Professor in the Radiology department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

Adult
Amnion
Catheterization
Compassionate Use Trials
Decompression
Female
Gestational Age
Humans
Hydrops Fetalis
Live Birth
Pregnancy
Retrospective Studies
Stents
Thorax
Treatment Outcome
Ultrasonography, Doppler, Color
Ultrasonography, Interventional
Ultrasonography, Prenatal
Young Adult