APSA paperDefining hydrops and indications for open fetal surgery for fetuses with lung masses and vascular tumors
Section snippets
Patient population
After approval from the Institutional Review Board of the Baylor College of Medicine (protocols H-20983, H-27447, and H-26009), the case records and diagnostic imaging studies of all fetuses referred to the Texas Children's Fetal Center between July 1, 2001, and March 1, 2011, with a diagnosis of lung mass, sacrococcygeal teratoma, or neck mass were reviewed retrospectively. For all patients with fetal lung mass, a cystic adenomatoid malformation-volume ratio (CVR) was calculated as previously
High-risk lung masses
During the study period, 95 fetuses were evaluated for a confirmed fetal lung mass of whom 26 (27%) were classified as high-risk lesions because of CVR greater than 1.6 (n = 25) or findings of fetal hydrops with unknown CVR (n = 1). Two fetuses diagnosed with mainstem bronchial atresia after comprehensive evaluation were excluded from analysis, leaving 24 fetuses (13 males) with high-risk lung masses (14 left sided, 10 right sided). One fetus, who underwent evaluation in 2001 and had no
Discussion
The findings in the present study suggest that fetal echocardiographic findings may be the best predictors of the need for fetal surgical resection for fetuses with high-risk lung masses. Although findings of early hydrops and echocardiographic changes are equally sensitive in detecting poor outcome for fetuses with these lesions, an abnormal echocardiogram and findings of fetal heart failure are more specific and thus superior indicators of impending fetal demise. These findings are consistent
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Prenatal ultrasound-and MRI-based imaging predictors of respiratory symptoms at birth for congenital lung malformations
2023, Journal of Pediatric SurgeryCitation Excerpt :This finding suggests that in our study population, ultrasound findings are more likely to be associated with postnatal respiratory outcomes when compared to the MRI measurement O/E NFLV. Additionally, although CVR is the most common ultrasound measurement used to predict outcomes in patients with CLM, absolute cyst volume should also be considered as an important tool to guide prenatal counseling and postnatal treatment [18–21]. The use of cyst volume is supported by Girsen et al. who reported maximal cyst volume > 34.0 cm3 as the strongest ultrasound predictor of respiratory distress in patients with CLM (100% sensitivity, 85% specificity, 54% positive predictive value, and 100% negative predictive value) [15].
Surgical Pulmonary and Pleural Diseases in Children: Lung Malformations, Empyema, and Spontaneous Pneumothorax
2020, Advances in PediatricsCitation Excerpt :Placentomegaly and polyhydramnios are also commonly seen. Untreated hydrops from severe mediastinal compression compromise cardiac venous return and ultimately lead to in utero heart failure [24,25]. Fortunately, hydrops is a relatively rare event, occurring in less than 10% of fetuses based on recent reports using multi-institutional data [13].
Tissue engineering and transplantation in the fetus
2020, Principles of Tissue EngineeringSacrococcygeal teratoma with intraspinal extension
2020, Journal of Pediatric Surgery Case ReportsCitation Excerpt :An accurate prenatal diagnostic assessment enables a correct risk-related patient stratification, on which to individually base on the parental counseling regarding fetal monitoring extent, maternity clinic selection and planning of pre- and postnatal surgical options [13,16,18,33]. A prenatal intervention is considered in a fetus <28–30 weeks at high-risk for preterm delivery and fetal demise due to e.g. an high-output cardiac failure (hydrops) or placentomegaly if left untreated [2,15,31,39–48]. Intrauterine therapy consists of closure of the feeding vessels with laser technology or open fetal surgery.
Short-term respiratory outcomes of neonates with symptomatic congenital lung malformations
2019, Journal of Pediatric SurgeryCitation Excerpt :The CPAM volume ratio (CVR) was prospectively measured throughout the pregnancy as previously detailed [17]. Hydrops was defined as the presence of fluid in two or more spaces, including ascites, pleural effusion, pericardial effusion, or skin edema, with fetal echocardiographic evidence to support heart dysfunction as reported elsewhere [25]. The pathologic diagnosis was confirmed in all resected specimens.
Congenital lung lesions
2019, Seminars in Pediatric Surgery