The ex utero intrapartum therapy procedure for high-risk fetal lung lesions
Section snippets
Patient population
From September 1995 through March 2004, a total of 272 pregnant women with fetal lung lesions were referred to The Center for Fetal Diagnosis and Treatment at the Children's Hospital of Philadelphia (CHOP). The initial evaluation at CHOP includes detailed fetal ultrasonography and fetal ultrafast magnetic resonance imaging. Assessment includes the type of fetal lung lesion, CVR, placental size and location, and the presence or absence of hydrops. Fetal echocardiography and Doppler flow
Results
During the study period, 272 pregnant women underwent evaluation for a prenatally diagnosed lung lesion. Sixteen patients with solid masses and hydrops underwent open fetal surgery with 50% survival. Twenty-three patients with macrocystic masses underwent shunt placement with 74% survival. Of those that continued postnatal care at CHOP, 35 patients underwent urgent operative intervention within the first week of life for respiratory distress (16 in first 24 hours) and 113 underwent elective
Discussion
The alternative to the EXIT procedure for resection of high-risk lung lesions is immediate decompressive thoracotomy in an often unstable hypoxic neonate. Patient selection for the EXIT procedure in the setting of a fetal lung lesion relies heavily on serial prenatal surveillance. The CVR is a useful objective measurement in tracking growth and regression of the lung mass [11]. Magnetic resonance imaging is useful for delineating feeding vessels, assessing lobar involvement, and more clearly
References (25)
- et al.
Treatment of severe congenital diaphragmatic hernia by fetal tracheal occlusion: clinical experience with fifteen cases
Am J Obstet Gynecol
(2000) - et al.
Correction of congenital diaphragmatic hernia in utero VIII: response of the hypoplastic lung to tracheal occlusion
J Pediatr Surg
(1996) - et al.
The EXIT procedure: experience and outcome in 31 cases
J Pediatr Surg
(2002) Ex utero intrapartum therapy
Semin Pediatr Surg
(2003)- et al.
Fetal lung lesions: management and outcome
Am J Obstet Gynecol
(1998) - et al.
Disappearing fetal lung lesions
J Pediatr Surg
(1993) Management of fetal lung lesions
Clin Perinatol
(2003)- et al.
Cystic adenomatoid malformation volume ratio predicts outcome in prenatally diagnosed cystic adenomatoid malformation of the lung
J Pediatr Surg
(2002) - et al.
Intrapartum airway management for giant fetal neck masses: the EXIT (ex utero intrapartum treatment) procedure
Am J Obstet Gynecol
(1997) - et al.
The ex utero intrapartum treatment procedure for a large fetal neck mass in a twin gestation
Obstet Gynecol
(1999)
Cited by (147)
Management and Outcomes of Patients With High-Risk (Congenital Lung Malformation Volume Ratio≥ 1.6) Congenital Lung Malformations
2024, Journal of Surgical ResearchNovel Clinical Algorithm for Prenatal Monitoring of Congenital Lung Malformations
2024, Journal of Surgical ResearchPrenatally Diagnosed Large Lung Lesions: Timing of Resection and Perinatal Outcomes
2023, Journal of Pediatric SurgeryPerinatal management of the anticipated difficult airway
2023, Seminars in Fetal and Neonatal MedicineManagement of Congenital Lung Malformations
2022, Clinics in PerinatologyMaternal Steroids in High-Risk Congenital Lung Malformations
2022, Journal of Surgical ResearchCitation Excerpt :Although some smaller lesions will remain stable or regress, almost half of lesions can have rapid growth to 28 wk gestation, when the lesion reaches a growth plateau.4-6 Rapid growth during this period has significant implications for the fetus, as it can cause mediastinal compression with high output cardiac failure leading to hydrops and potentially intrauterine fetal demise (IUFD).7,8 The CLM volume ratio (CVR) has been described as a metric to help identify patients who are at risk for prenatal hydrops and perinatal respiratory distress.9-13
Presented at the 56th Annual Meeting of the Section on Surgery of the American Academy of Pediatrics, San Francisco, California, October 8-10, 2004.