Fetoscopy-Assisted Percutaneous Decompression of the Distal Trachea and Lungs Reverses Hydrops Fetalis and Fetal Distress in a Fetus with Laryngeal Atresia
| Autor: | Clara T. Nicolas, Stephanie A Eyerly-Webb, Ellen M. Bendel-Stenzel, Robert Tibesar, David Lynch-Salamon, Francois I. Luks, Joseph B. Lillegard |
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| Rok vydání: | 2019 |
| Předmět: |
Embryology
medicine.medical_specialty 030219 obstetrics & reproductive medicine medicine.diagnostic_test business.industry Fetal surgery medicine.medical_treatment Laryngoscopy Obstetrics and Gynecology General Medicine Airway obstruction medicine.disease Pericardial effusion Surgery Fetoscopy 03 medical and health sciences 0302 clinical medicine Hydrops fetalis Pediatrics Perinatology and Child Health medicine Fetal distress Radiology Nuclear Medicine and imaging Fetal head 030212 general & internal medicine business |
| Zdroj: | Fetal Diagnosis and Therapy. 46:75-80 |
| ISSN: | 1421-9964 1015-3837 |
| Popis: | We present a case of prenatal hydrops secondary to congenital high airway obstruction syndrome (CHAOS) that was treated with fetoscopy-assisted needle decompression. A 22-year-old G3P2 woman presented after a 21-week ultrasound demonstrated CHAOS. The fetus developed hydrops at 25 weeks, characterized by abdominal ascites, pericardial effusion, and scalp edema. Fetal MRI showed complete obstruction of the glottis and subglottic airway, suggestive of laryngeal atresia. At 27 weeks, due to the progression of the hydrops, operative fetoscopy was proposed and performed. Fetal laryngoscopy confirmed fusion of the vocal cords and laryngeal atresia. The atretic segment was a solid cartilaginous block, preventing intubation. Using the fetoscope to stabilize the fetal head and neck, we performed ultrasound-guided percutaneous needle drainage of the cervical trachea through the anterior fetal neck. We removed 17 mL of viscous fluid from the lower trachea, resulting in immediate lung decompression. Two weeks later, ultrasound confirmed hydrops resolution. The patient was delivered and tracheostomy performed at 30 weeks via an ex utero intrapartum treatment (EXIT) procedure after progression of preterm labor. At 27 days of life, the infant was stable on minimal ventilator support. To our knowledge, this is the first successful report of an ultrasound-guided percutaneous tracheal decompression through the anterior neck of a fetus with CHAOS secondary to laryngeal atresia. |
| Databáze: | OpenAIRE |
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