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Ultrasound Obstet Gynecol. 2017 Jun;49(6):744-750. doi: 10.1002/uog.16011. Epub 2017 May 2.

Fetal laser ablation of feeding artery of cystic lung lesions with systemic arterial blood supply.

Author information

1
National Fetal Medicine Research Network 'Fetal Medicine Mexico', Queretaro, Mexico.
2
Fetal Medicine and Surgery Research Unit, Children's and Women's Specialty Hospital of Queretaro, and Unidad de Investigación en Neurodesarrollo, Instituto de Neurobiología, Universidad Nacional Autónoma de México (UNAM) Campus Juriquilla, Queretaro, Mexico.
3
Department of Neonatology, Children's and Women's Specialty Hospital of Queretaro, Queretaro, Mexico.

Abstract

OBJECTIVE:

To assess the effectiveness of laser surgery in fetuses with a cystic lung lesion with systemic arterial blood supply (hybrid lung lesion) at risk of perinatal death.

METHODS:

A cohort of five consecutive fetuses with a large hybrid lung lesion associated with hydrops and/or pleural effusion with severe lung compression was selected for percutaneous ultrasound-guided fetal laser ablation of the feeding artery (FLAFA) before 32 weeks' gestation in a single tertiary national referral center in Queretaro, Mexico. The primary outcomes were survival and need for postnatal surgery.

RESULTS:

FLAFA was performed successfully in all cases at a median gestational age of 24.9 (range, 24.4-31.7) weeks. After fetal intervention, dimensions in both lungs increased and fluid effusions resolved in all cases. All cases were delivered liveborn at term at a median gestational age of 39.6 (range, 38.0-39.7) weeks, without respiratory morbidity or need for oxygen support, resulting in perinatal survival of 100%. During follow-up, three (60%) cases showed progressive regression of the entire lung mass and did not require postnatal surgery, whereas in two (40%) cases a progressive decrease in size of the mass was observed but a cystic portion of the lung mass persisted and postnatal lobectomy was required.

CONCLUSION:

In fetuses with large hybrid lung lesions at risk of perinatal death, FLAFA is feasible and could improve survival and decrease the need for postnatal surgery. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

KEYWORDS:

bronchopulmonary sequestration; congenital cystic adenomatoid malformation; fetal surgery; hybrid lung lesion; laser therapy

Comment in

PMID:
27363854
DOI:
10.1002/uog.16011
[Indexed for MEDLINE]
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