Intrauterine Ultrasound-Guided Laser Coagulation as a First Step for Treatment of Prenatally Complicated Bronchopulmonary Sequestration: Our Experience and Literature Review

Abstract

Introduction Prenatal ultrasound-guided laser coagulation (USLC) for complicated bronchopulmonary sequestrations has been described but a consensus on the procedure and on the following management is still lacking. We present our experience and provide a literature review.

Methods Retrospective review of patients treated in our center. Literature review and combined analysis of perinatal data were performed.

Results Five cases were treated at our center, all presenting with severe hydrothorax. Four met the criteria for fetal hydrops. Four cases underwent postnatal computed tomography (CT) scan: in one case, there was no evidence of persistent bronchopulmonary sequestration. The other three underwent thoracoscopic resection, in two, a viable sequestration was found. Including our series, 57 cases have been reported, with no mortality and a success rate of 94.7%. Mean gestational age (GA) at the procedure was 28 ± 3.4 weeks and mean GA at birth and birth weight (BW) were 38.6 ± 2.3 weeks and 3,276 ± 519.8 g, respectively. In 80.6% of the cases investigated postnatally, a residual mass was found, 50% of cases who showed prenatal arterial flow cessation had a persistent sequestration postnatally, and 26.3% of cases underwent postnatal sequestrectomy. Both patients in our series had pathology examination confirming a viable bronchopulmonary sequestration.

Conclusion Prenatal USLC seems to be a valid option for bronchopulmonary sequestration complicated by severe hydrothorax and/or fetal hydrops. Authors believe that this procedure should aim to reverse fetal distress and allow pregnancy continuation, and it should not be considered a definitive treatment. The currently available data do not support changes of the common postnatal management.

Keywords

fetal surgery - prenatal laser - bronchopulmonary sequestration - congenital lung malformation - thoracoscopy

Publikationsverlauf

Eingereicht: 02. Oktober 2021

Angenommen: 17. Januar 2022

Artikel online veröffentlicht:
14. März 2022

• References

• 1 Adzick NS. Fetal thoracic lesions. Semin Pediatr Surg 1993; 2 (02) 103-108
• 2 Cavoretto P, Molina F, Poggi S, Davenport M, Nicolaides KH. Prenatal diagnosis and outcome of echogenic fetal lung lesions. Ultrasound Obstet Gynecol 2008; 32 (06) 769-783
• 3 Zobel M, Gologorsky R, Lee H, Vu L. Congenital lung lesions. Semin Pediatr Surg 2019; 28 (04) 150821
• 4 Riley JS, Urwin JW, Oliver ER. et al. Prenatal growth characteristics and pre/postnatal management of bronchopulmonary sequestrations. J Pediatr Surg 2018; 53 (02) 265-269
• 5 Ruano R, Ramalho AS, Cardoso AKS, Moise Jr. K, Zugaib M. Prenatal diagnosis and natural history of fetuses presenting with pleural effusion. Prenat Diagn 2011; 31 (05) 496-499
• 6 Abrams ME, Meredith KS, Kinnard P, Clark RH. Hydrops fetalis: a retrospective review of cases reported to a large national database and identification of risk factors associated with death. Pediatrics 2007; 120 (01) 84-89
• 7 Witlox RSGM, Klumper FJCM, Te Pas AB, van Zwet EW, Oepkes D, Lopriore E. Neonatal management and outcome after thoracoamniotic shunt placement for fetal hydrothorax. Arch Dis Child Fetal Neonatal Ed 2018; 103 (03) F245-F249
• 8 Mann S, Johnson MP, Wilson RD. Fetal thoracic and bladder shunts. Semin Fetal Neonatal Med 2010; 15 (01) 28-33
• 9 Abbasi N, Windrim R, Keunen J. et al. Perinatal outcome in fetuses with dislodged thoraco-amniotic shunts. Fetal Diagn Ther 2021; 48 (06) 430-439
• 10 Macchini F, Gentilino V, Morandi A, Leva E. Thoracoscopic removal of retained thoracoamniotic shunt catheters in newborns. J Laparoendosc Adv Surg Tech A 2014; 24 (11) 827-829
• 11 Nassr AA, Ruano R, Espinoza J, Shamshirsaz AA. Successful in utero percutaneous fetoscopic release of a wrapped pleuro-amniotic shunt around the fetal arm: case report and review of the literature. Fetal Diagn Ther 2018; 43 (02) 156-160
• 12 Oepkes D, Devlieger R, Lopriore E, Klumper FJCM. Successful ultrasound-guided laser treatment of fetal hydrops caused by pulmonary sequestration. Ultrasound Obstet Gynecol 2007; 29 (04) 457-459
• 13 Grozdeva L, Senat M-V, Vandewynckele N. et al. Antenatal management of bronchopulmonary sequestration by intrafetal vascular laser ablation under ultrasound control: narrative review of the literature and report of three cases. Fetal Diagn Ther 2021; 48 (01) 34-42
• 14 Ichino M, Macchini F, Morandi A. et al. Combined pre- and postnatal minimally invasive approach to complicated pulmonary sequestrations. European J Pediatr Surg Rep 2020; 8 (01) e62-e67
• 15 Ruano R, da Silva MM, Salustiano EMA, Kilby MD, Tannuri U, Zugaib M. Percutaneous laser ablation under ultrasound guidance for fetal hyperechogenic microcystic lung lesions with hydrops: a single center cohort and a literature review. Prenat Diagn 2012; 32 (12) 1127-1132
• 16 Witlox RSGM, Lopriore E, Walther FJ, Rikkers-Mutsaerts ERVM, Klumper FJCM, Oepkes D. Single-needle laser treatment with drainage of hydrothorax in fetal bronchopulmonary sequestration with hydrops. Ultrasound Obstet Gynecol 2009; 34 (03) 355-357
• 17 Rammos KS, Foroulis CN, Rammos CK, Andreou A. Prenatal interventional and postnatal surgical therapy of extralobar pulmonary sequestration. Interact Cardiovasc Thorac Surg 2010; 10 (04) 634-635
• 18 Baud D, Windrim R, Kachura JR. et al. Minimally invasive fetal therapy for hydropic lung masses: three different approaches and review of the literature. . Ultrasound Obstet Gynecol 2013; 42 (04) 440-448 PubMed
• 19 Mallmann MR, Geipel A, Bludau M. et al. Bronchopulmonary sequestration with massive pleural effusion: pleuroamniotic shunting vs intrafetal vascular laser ablation. Ultrasound Obstet Gynecol 2014; 44 (04) 441-446
• 20 Gottschalk I, Strizek B, Mallmann MR. et al. Outcome of bronchopulmonary sequestration with massive pleural effusion after intrafetal vascular laser ablation. Fetal Diagn Ther 2018; 44 (02) 149-155
• 21 Kosinski P, Tavares de Sousa M, Wielgos M, Hecher K. Intrauterine ultrasound-guided laser coagulation of the feeding artery in fetal bronchopulmonary sequestration. Ultraschall Med 2017; 38 (06) 583-586
• 22 Cruz-Martínez R, Nieto-Castro B, Martínez-Rodríguez M. et al. Thoracic changes after full laser ablation of the feeding artery in fetuses with bronchopulmonary sequestration. Fetal Diagn Ther 2018; 44 (03) 166-172
• 23 Sala P, Prefumo F, Pastorino D. et al. Fetal surgery: an overview. Obstet Gynecol Surv 2014; 69 (04) 218-228
• 24 Peiro JL, Crombleholme TM. Error traps in fetal surgery. Semin Pediatr Surg 2019; 28 (03) 143-150
• 25 Kelly EN, Seaward G, Ye XY. et al. Short- and long-term outcome following thoracoamniotic shunting for fetal hydrothorax. Ultrasound Obstet Gynecol 2021; 57 (04) 624-630
• 26 Hall NJ, Stanton MP. Long-term outcomes of congenital lung malformations. Semin Pediatr Surg 2017; 26 (05) 311-316
• 27 Macchini F, Borzani I, Cavalli S. et al. Thoracoscopic resection of congenital lung malformation: looking for the right preoperative assessment. Eur J Pediatr Surg 2020; 30 (05) 452-458
• 28 Casagrande A, Pederiva F. Association between congenital lung malformations and lung tumors in children and adults: a systematic review. J Thorac Oncol 2016; 11 (11) 1837-1845
• 29 Annunziata F, Bush A, Borgia F. et al. Congenital lung malformations: unresolved issues and unanswered questions. Front Pediatr 2019; 7: 239
• 30 Westphal FL, Lima LC, Lima Netto JC, Cardoso MdoS, Silva MdosS, Westphal DC. Carcinoid tumor and pulmonary sequestration. J Bras Pneumol 2012; 38 (01) 133-137
• 31 Hekelaar N, van Uffelen R, van Vliet AC, Varin OC, Westenend PJ. Primary lymphoepithelioma-like carcinoma within an intralobular pulmonary sequestration. Eur Respir J 2000; 16 (05) 1025-1027
• 32 Macchini F, Zanini A, Morandi A, Ichino M, Leva E. Thoracoscopic surgery for congenital lung malformation using miniaturized 3-mm vessel sealing and 5-mm stapling devices: single-center experience. J Laparoendosc Adv Surg Tech A 2020; 30 (04) 444-447