medigraphic.com
Federación Mexicana de Ginecología y Obstetricia, A.C.

2019, Number 02

<< Back Next >>

Ginecol Obstet Mex 2019; 87 (02)

Bronchopulmonary Sequestration. Prenatal diagnosis, prognostic factors and treatment by fetal surgery

Cruz-Martínez R, Ordorica-Flores R

Language: Spanish
References: 29
Page: 116-124
PDF size: 349.70 Kb.


ABSTRACT

Background: The bronchopulmonary sequestration (BPS) is usually diagnosed prenatally as an intrathoracic hyperechoic, homogeneous, solid mass usually located in the lower pulmonary lobe. The pathognomonic sign is the demonstration of its systemic feeding artery into the lung mass by using color Doppler ultrasound. Natural history data reports that a significant proportion of BPS cases usually regress in the intrauterine period. However, a proportion of cases showed a rapid and progressive growth with development of massive pleural effusion and hydrops. Such cases present the poorest prognosis and high perinatal mortality and therefore, fetal intervention should be considered to improve prognosis. Different fetal surgery procedures have been attempted for such purposes. However, the optimal fetal therapeutica strategy remains controversial.
Objective: In the present manuscript, we describe and discuss the perinatal outcome of the different published fetal interventions in fetuses complicated with BPS.
Methodology: We search in the English and Spanish literature (Medline and PubMed) for cases complicated with BPS and treated with any fetal surgical intervention including the key words “broncopulmonary sequestration” and “fetal surgery” from 1990 to 2019.
Results: A total of 150 references were reviewed including only 26 studies describing pregnancies with prenatal diagnosis of bronchopulmonary sequestration that were treated with any fetal surgical intervention. Several fetal surgery procedures have been attempted for the management of complicated fetuses with severe BPS. These include open fetal surgery, placement of thoracoamniotic shunts, and occlusion of the feeding blood vessel by ultrasound-guided intrafetal laser coagulation, radiofrequency ablation, coil embolization, sclerotherapy with intravascular alcohol injection and fetal bronchoscopy.
Conclusions: Laser coagulation of the feeding artery appears to be the best intervention, avoiding fetal death, neonatal pulmonary morbidity and the need for postnatal surgery in virtually all cases postulating itself as the only potential curative management.


REFERENCES

  1. Adzick NS. Management of fetal lung lesions. Clin Perinatol 2009;36:363-76. https://doi.org/10.1016/j. clp.2009.03.001

  2. Stocker LJ, et al. The increasing incidence of foetal echogenic congenital lung malformations: an observational study. Prenat Diagn 2015;35:148-53. https://doi.org/10.1002/ pd.4507

  3. Stocker JT. Sequestrations of the lung. Semin Diagn Pathol 1986;3:106-21

  4. Corbett HJ, Humphrey GM. Pulmonary sequestration. Paediatr Respir Rev 2004;5:59-68.

  5. Ruano R, et al. Prenatal diagnosis of pulmonary sequestration using three-dimensional power Doppler ultrasound. Ultrasound Obstet Gynecol 2005;25:128-33. https://doi. org/10.1002/uog.1797

  6. York D, et al. Prenatal detection and evaluation of an extralobar pulmonary sequestration in the posterior mediastinum. Ultrasound Obstet Gynecol 2006;27:214-6. https://doi.org/10.1002/uog.2667

  7. Hellmund A, Berg C, Geipel A, et al. Prenatal Diagnosis and Evaluation of Sonographic Predictors for Intervention and Adverse Outcome in Congenital Pulmonary Airway Malformation. PLoS One 2016. https://doi.org/10.1371/ journal.pone.0150474

  8. Cruz-Martinez R, Gratacos E. [Endoscopic fetal surgery]. Ginecol Obstet Mex 2014;82:325-36

  9. Mahle WT, et al. Echocardiographic evaluation of the fetus with congenital cystic adenomatoid malformation. Ultrasound Obstet Gynecol 2000;16:620-4. https://doi. org/10.1046/j.1469-0705.2000.00254.x

  10. Mann S, et al. Antenatal diagnosis and management of congenital cystic adenomatoid malformation. Semin Fetal Neonatal Med 2007;12:477-81. https://doi.org/10.1016/j. siny.2007.06.009

  11. Lopoo JB, et al. Fetal pulmonary sequestration: a favorable congenital lung lesion. Obstet Gynecol 1999;94:567-71. https://doi.org/10.1016/S0029-7844(99)00420-2

  12. Cass DL, et al. Cystic lung lesions with systemic arterial blood supply: a hybrid of congenital cystic adenomatoid malformation and bronchopulmonary sequestration. J Pediatr Surg 1997;32:986-90. https://doi.org/10.1016/ S0022-3468(97)90383-3

  13. Adzick NS. Open fetal surgery for life-threatening fetal anomalies. Semin Fetal Neonatal Med 2010;15:1-8. https:// doi.org/10.1016/j.siny.2009.05.003

  14. Kitano Y, et al. Open fetal surgery for life-threatening fetal malformations. Semin Perinatol 1999;23:448-61. https:// doi.org/10.1016/S0146-0005(99)80024-X

  15. Slotnick RN, et al. Antenatal diagnosis and treatment of fetal bronchopulmonary sequestration. Fetal Diagn Ther 1990;5:33-9. https://doi.org/10.1159/000263532

  16. Salomon LJ, et al. Fetal thoracoamniotic shunting as the only treatment for pulmonary sequestration with hydrops: favorable long-term outcome without postnatal surgery. Ultrasound Obstet Gynecol 2003;21:299-301. https://doi. org/10.1002/uog.76

  17. Hayashi S, et al. Fetal pleuroamniotic shunting for bronchopulmonary sequestration with hydrops. Ultrasound Obstet Gynecol 2006;28:963-7. https://doi.org/10.1002/uog.3861

  18. Mallmann MR, et al. Bronchopulmonary sequestration with massive pleural effusion: pleuroamniotic shunting vs intrafetal vascular laser ablation. Ultrasound Obstet Gynecol 2014;44:441-6. https://doi.org/10.1002/uog.13304

  19. Nicolini U, et al. A new approach to prenatal treatment of extralobar pulmonary sequestration. Prenat Diagn 2000;20:758-60. https://doi.org/10.1002/1097- 0223(200009)20:9<758

  20. Bermudez C, et al. Percutaneous ultrasound-guided sclerotherapy for complicated fetal intralobar bronchopulmonary sequestration. Ultrasound Obstet Gynecol 2007;29:586-9. https://doi.org/10.1002/uog.3944

  21. Oepkes D, et al. Successful ultrasound-guided laser treatment of fetal hydrops caused by pulmonary sequestration. Ultrasound Obstet Gynecol 2007;29:457-9. https:// doi.org/10.1002/uog.3984

  22. Ruano R, et al. Percutaneous intrauterine laser ablation of the abnormal vessel in pulmonary sequestration with hydrops at 29 weeks' gestation. J Ultrasound Med 2007;26:1235-41. https://doi.org/10.7863/ jum.2007.26.9.1235

  23. Witlox RS, et al. Single-needle laser treatment with drainage of hydrothorax in fetal bronchopulmonary sequestration with hydrops. Ultrasound Obstet Gynecol 2009;34:355-7. https://doi.org/10.1002/uog.7316

  24. Ruano R, et al. Percutaneous laser ablation under ultrasound guidance for fetal hyperechogenic microcystic lung lesions with hydrops: a single center cohort and a literature review. Prenat Diagn 2012;32:1127-32. https:// doi.org/10.1002/pd.3969

  25. Baud D, et al. Minimally invasive fetal therapy for hydropic lung masses: three different approaches and review of the literature. Ultrasound Obstet Gynecol 2013;42:440-8. https://doi.org/10.1002/uog.12515

  26. Cruz-Martinez R, et al. Fetal laser surgery prevents fetal death and avoids the need for neonatal sequestrectomy in cases with bronchopulmonary sequestration. Ultrasound Obstet Gynecol 2015;46:627-8. https://doi.org/10.1002/uog.14921

  27. Cruz-Martinez R, et al. Thoracic Changes after Full Laser Ablation of the Feeding Artery in Fetuses with Bronchopulmonary Sequestration. Fetal Diagn Ther 2018;44:166-72. DOI:10.1159/000481170

  28. Gottschalk I, et al. Outcome of Bronchopulmonary Sequestration with Massive Pleural Effusion after Intrafetal Vascular Laser Ablation. Fetal Diagn Ther 2018;44:149-55. https://doi.org/10.1159/000479793

  29. Quintero RA, et al. Fetal bronchoscopy: its successful use in a case of extralobar pulmonary sequestration. J Matern Fetal Neonatal Med 2012;25:2354-8. https://doi.org/10.3 109/14767058.2012.695826




2020     |     www.medigraphic.com