Document Detail


Percutaneous laser ablation of fetal congenital cystic adenomatoid malformation: too little, too late?
MedLine Citation:
PMID:  11111218     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: Congenital cystic adenomatoid malformation, type III (CCAM III) lesions are large, bulky tumors which can cause mediastinal shift, prevent normal pulmonary growth, and compress the esophagus, thus leading to complications of nonimmune hydrops, pulmonary hypoplasia and polyhydramnios. Because the mortality rate of untreated fetuses with CCAM and hydrops is high, early delivery or intrauterine resection of the enlarged pulmonary lobe (lobectomy) is indicated; however, open fetal resection of CCAM at less than 30 weeks is associated with perioperative mortality that approaches 40%, as well as the usual maternal and fetal morbidity of open fetal surgery. As an alternative, percutaneous laser ablation of a CCAM III lesion with hydrops was attempted. METHODS: A 30-year-old G3 P1011 with CCAM III in the left fetal hemithorax developed mediastinal shift, hydrops and polyhydramnios at 23 weeks' gestation. After pregnancy termination and open fetal resection were declined, an 18-gauge needle was placed into the fetal tumor percutaneously under real-time ultrasonographic guidance, using sterile technique with light sedation. A cleaved 400-microm Nd:YAG laser fiber was passed through the needle lumen, and using a power setting of 15 W, a total of 2,943 J of laser energy was delivered in pulses of 1.0 s at 0.2-second intervals over two sessions one week apart. RESULTS: Although tumor size decreased, the hydrops worsened and fetal death occurred. CONCLUSIONS: The fetus with CCAM complicated by hydrops is already so compromised by the advanced state of the disease that insufficient time is available for necrotic tissue reabsorption after minimally invasive therapy with laser energy. Until earlier markers for intervention are determined, percutaneous laser debulking of CCAM is unlikely to be successful.
Authors:
J P Bruner; B K Jarnagin; L Reinisch
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Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Fetal diagnosis and therapy     Volume:  15     ISSN:  1015-3837     ISO Abbreviation:  Fetal. Diagn. Ther.     Publication Date:    2000 Nov-Dec
Date Detail:
Created Date:  2001-01-12     Completed Date:  2001-02-01     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  9107463     Medline TA:  Fetal Diagn Ther     Country:  SWITZERLAND    
Other Details:
Languages:  eng     Pagination:  359-63     Citation Subset:  IM    
Copyright Information:
Copyright 2000 S. Karger AG, Basel
Affiliation:
Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, TN 37232-2519, USA. joe.bruner@mcmail.vanderbilt.edu
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MeSH Terms
Descriptor/Qualifier:
Catheter Ablation / methods*
Cystic Adenomatoid Malformation of Lung, Congenital / therapy*
Female
Fetal Diseases / therapy*
Humans
Hyperthermia, Induced / methods*
Lasers
Lung / abnormalities
Pregnancy

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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