Percutaneous in utero thoracoamniotic shunt creation for fetal thoracic abnormalities leading to nonimmune hydrops

Sarah B. White, Sean M. Tutton, William S. Rilling, Randall S. Kuhlmann, Erika L. Peterson, Thomas R. Wigton, Mary B. Ames

Research output: Contribution to journalArticle

Abstract

Purpose To describe a transabdominal, transuterine Seldinger-based percutaneous approach to create a shunt for treatment of fetal thoracic abnormalities. Materials and Methods Five fetuses presented with nonimmune fetal hydrops secondary to fetal thoracic abnormalities causing severe mass effect. Under direct ultrasound guidance, an 18-gauge needle was used to access the malformation. Through a peel-away sheath, a customized pediatric transplant 4.5-F double J ureteral stent was advanced; the leading loop was placed in the fetal thorax, and the trailing end was left outside the fetal thorax within the amniotic cavity. Results Seven thoracoamniotic shunts were successfully placed in five fetuses; one shunt was immediately replaced because of displacement during the procedure, and another shunt was not functioning at follow-up requiring insertion of a second shunt. All fetuses had successful decompression of the thoracic malformation, allowing lung reexpansion and resolution of hydrops. Three of five mothers had meaningful (> 7 d) prolongation of their pregnancies. All pregnancies were maintained to > 30 weeks (range, 30 weeks 1 d-37 weeks 2 d). There were no maternal complications. Conclusions A Seldinger-based percutaneous approach to draining fetal thoracic abnormalities is feasible and can allow for prolongation of pregnancy and antenatal lung development and ultimately result in fetal survival.

Original languageEnglish (US)
Pages (from-to)889-894
Number of pages6
JournalJournal of Vascular and Interventional Radiology
Volume25
Issue number6
DOIs
StatePublished - 2014

Fingerprint

Edema
Thorax
Fetus
Pregnancy
Hydrops Fetalis
Lung
Decompression
Needles
Stents
Mothers
Pediatrics
Transplants
Therapeutics

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine
  • Medicine(all)

Cite this

White, S. B., Tutton, S. M., Rilling, W. S., Kuhlmann, R. S., Peterson, E. L., Wigton, T. R., & Ames, M. B. (2014). Percutaneous in utero thoracoamniotic shunt creation for fetal thoracic abnormalities leading to nonimmune hydrops. Journal of Vascular and Interventional Radiology, 25(6), 889-894. https://doi.org/10.1016/j.jvir.2014.02.009

Percutaneous in utero thoracoamniotic shunt creation for fetal thoracic abnormalities leading to nonimmune hydrops. / White, Sarah B.; Tutton, Sean M.; Rilling, William S.; Kuhlmann, Randall S.; Peterson, Erika L.; Wigton, Thomas R.; Ames, Mary B.

In: Journal of Vascular and Interventional Radiology, Vol. 25, No. 6, 2014, p. 889-894.

Research output: Contribution to journalArticle

White, Sarah B. ; Tutton, Sean M. ; Rilling, William S. ; Kuhlmann, Randall S. ; Peterson, Erika L. ; Wigton, Thomas R. ; Ames, Mary B. / Percutaneous in utero thoracoamniotic shunt creation for fetal thoracic abnormalities leading to nonimmune hydrops. In: Journal of Vascular and Interventional Radiology. 2014 ; Vol. 25, No. 6. pp. 889-894.
@article{e55b6a34227f40ab80255702bfd67319,
title = "Percutaneous in utero thoracoamniotic shunt creation for fetal thoracic abnormalities leading to nonimmune hydrops",
abstract = "Purpose To describe a transabdominal, transuterine Seldinger-based percutaneous approach to create a shunt for treatment of fetal thoracic abnormalities. Materials and Methods Five fetuses presented with nonimmune fetal hydrops secondary to fetal thoracic abnormalities causing severe mass effect. Under direct ultrasound guidance, an 18-gauge needle was used to access the malformation. Through a peel-away sheath, a customized pediatric transplant 4.5-F double J ureteral stent was advanced; the leading loop was placed in the fetal thorax, and the trailing end was left outside the fetal thorax within the amniotic cavity. Results Seven thoracoamniotic shunts were successfully placed in five fetuses; one shunt was immediately replaced because of displacement during the procedure, and another shunt was not functioning at follow-up requiring insertion of a second shunt. All fetuses had successful decompression of the thoracic malformation, allowing lung reexpansion and resolution of hydrops. Three of five mothers had meaningful (> 7 d) prolongation of their pregnancies. All pregnancies were maintained to > 30 weeks (range, 30 weeks 1 d-37 weeks 2 d). There were no maternal complications. Conclusions A Seldinger-based percutaneous approach to draining fetal thoracic abnormalities is feasible and can allow for prolongation of pregnancy and antenatal lung development and ultimately result in fetal survival.",
author = "White, {Sarah B.} and Tutton, {Sean M.} and Rilling, {William S.} and Kuhlmann, {Randall S.} and Peterson, {Erika L.} and Wigton, {Thomas R.} and Ames, {Mary B.}",
year = "2014",
doi = "10.1016/j.jvir.2014.02.009",
language = "English (US)",
volume = "25",
pages = "889--894",
journal = "Journal of Vascular and Interventional Radiology",
issn = "1051-0443",
publisher = "Elsevier Inc.",
number = "6",

}

TY - JOUR

T1 - Percutaneous in utero thoracoamniotic shunt creation for fetal thoracic abnormalities leading to nonimmune hydrops

AU - White, Sarah B.

AU - Tutton, Sean M.

AU - Rilling, William S.

AU - Kuhlmann, Randall S.

AU - Peterson, Erika L.

AU - Wigton, Thomas R.

AU - Ames, Mary B.

PY - 2014

Y1 - 2014

N2 - Purpose To describe a transabdominal, transuterine Seldinger-based percutaneous approach to create a shunt for treatment of fetal thoracic abnormalities. Materials and Methods Five fetuses presented with nonimmune fetal hydrops secondary to fetal thoracic abnormalities causing severe mass effect. Under direct ultrasound guidance, an 18-gauge needle was used to access the malformation. Through a peel-away sheath, a customized pediatric transplant 4.5-F double J ureteral stent was advanced; the leading loop was placed in the fetal thorax, and the trailing end was left outside the fetal thorax within the amniotic cavity. Results Seven thoracoamniotic shunts were successfully placed in five fetuses; one shunt was immediately replaced because of displacement during the procedure, and another shunt was not functioning at follow-up requiring insertion of a second shunt. All fetuses had successful decompression of the thoracic malformation, allowing lung reexpansion and resolution of hydrops. Three of five mothers had meaningful (> 7 d) prolongation of their pregnancies. All pregnancies were maintained to > 30 weeks (range, 30 weeks 1 d-37 weeks 2 d). There were no maternal complications. Conclusions A Seldinger-based percutaneous approach to draining fetal thoracic abnormalities is feasible and can allow for prolongation of pregnancy and antenatal lung development and ultimately result in fetal survival.

AB - Purpose To describe a transabdominal, transuterine Seldinger-based percutaneous approach to create a shunt for treatment of fetal thoracic abnormalities. Materials and Methods Five fetuses presented with nonimmune fetal hydrops secondary to fetal thoracic abnormalities causing severe mass effect. Under direct ultrasound guidance, an 18-gauge needle was used to access the malformation. Through a peel-away sheath, a customized pediatric transplant 4.5-F double J ureteral stent was advanced; the leading loop was placed in the fetal thorax, and the trailing end was left outside the fetal thorax within the amniotic cavity. Results Seven thoracoamniotic shunts were successfully placed in five fetuses; one shunt was immediately replaced because of displacement during the procedure, and another shunt was not functioning at follow-up requiring insertion of a second shunt. All fetuses had successful decompression of the thoracic malformation, allowing lung reexpansion and resolution of hydrops. Three of five mothers had meaningful (> 7 d) prolongation of their pregnancies. All pregnancies were maintained to > 30 weeks (range, 30 weeks 1 d-37 weeks 2 d). There were no maternal complications. Conclusions A Seldinger-based percutaneous approach to draining fetal thoracic abnormalities is feasible and can allow for prolongation of pregnancy and antenatal lung development and ultimately result in fetal survival.

UR - http://www.scopus.com/inward/record.url?scp=84901617865&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84901617865&partnerID=8YFLogxK

U2 - 10.1016/j.jvir.2014.02.009

DO - 10.1016/j.jvir.2014.02.009

M3 - Article

C2 - 24702750

AN - SCOPUS:84901617865

VL - 25

SP - 889

EP - 894

JO - Journal of Vascular and Interventional Radiology

JF - Journal of Vascular and Interventional Radiology

SN - 1051-0443

IS - 6

ER -