Denise B. Klinkner, Thomas Atwell, Ayssa Teles Abrao Trad, Matthew R. Callstrom, Mohamed Yasir Qureshi, Ellen Bendel Stenzel, Mauro Schenone, Rodrigo Ruano
Mayo Clinic. University of Miami.
United States
Fetal Diagnosis and Therapy
Fetal Diagn Ther 2022; 49: 250-255
DOI: 10.1159/000521690
Abstract
Introduction: Congenital pulmonary airway malformations (CPAMs) complicated by hydrops portend significant morbidity and mortality, with fetal survival estimates less than 10%.
Case presentation: We report successful use of ultrasound-guided radiofrequency ablation at 21-week gestation in a hydropic fetus with CPAM, with subsequent resolution of hydrops. Thirty-two-week MRI noted persistent mediastinal shift, and US at 36 weeks and 5 days noted polyhydramnios. Maternal gestational hypertension prompted delivery at 37 weeks, with a cesarean section performed after a failed trial of labor. The infant required CPAP at 100% and weaned to 21%. Tachypnea persisted, and chest CT on day of life 2 demonstrated multiple large cysts in the right lower lobe with anterior pneumothorax. On day of life 3, she successfully underwent a thoracoscopic right lower lobectomy. Adhesions to the chest wall and rib abnormalities were noted. She was extubated to CPAP at the conclusion of the procedure. She was able to wean to 21% on POD2 and transitioned to oral feeds. Her chest tube was removed with resultant ex vacuo pneumothorax noted. She remained asymptomatic and was discharged home on room air POD11. Pathology confirmed a type 1 CPAM.
Conclusion: In utero radiofrequency ablation may be an adjunct to the management of large CPAM.
Category
Class III. Pulmonary Hypertension Associated with Lung Hypoplasia
Surgical and Catheter-mediated Interventions for Pulmonary Vascular Disease
Age Focus: Pediatric Pulmonary Vascular Disease
Fresh or Filed Publication: Filed (PHiled). Greater than 1-2 years since publication
Article Access
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