Outcome of fetuses with bronchopulmonary sequestration after intrafetal vascular laser ablation
Purpose: To assess the outcome of fetuses with bronchopulmonary sequestration (BPS) with severe pleural effusions after intrafetal vascular laser ablation (VLA).
Methods: All fetuses with PBS and severe pleural effusions, that were treated with intrafetal VLA in a 5-year period, were reviewed retrospectively for clinical success rate of VLA, reliability of sonographic assessment of regression and prediction of postnatal need for sequestrectomy.
Results: In the study period, a total of 10 fetuses with BPS and severe pleural effusions were treated with intrafetal laser ablation of the feeding vessel. 9 fetuses had left-sided and 1 fetus had right-sided BPS. All had significant mediastinal shift and polyhydramnios, but normal doppler flow parameters. Median age at time of intrafetal VLA was 31+5 weeks of gestation (24+0 – 33+5 weeks). In 7 fetuses, only one intrafetal VLA was performed, while in 3 fetuses a second intervention was necessary within 72 hours because of recurrent flow in the feeding vessel. Finally, in 9 of 10 fetuses the feeding vessel could be coagulated completely and the pleural effusions dissolved. In one fetus, preterm rupture of membranes with subsequent amniotic infection syndrome and delivery at 30 weeks occured after unsuccessful VLA and pleural drainage. Postnatally, 4 fetuses required sequestrectomy because of residual sequestration. Sonographic evaluation of regression (partial or complete) prior to delivery was false in 3 of 10 fetuses. All neonates survived healthy.
Conclusion: Intrafetal laser ablation of the feeding vessel is an effective and successful treatment of BPS with rare necessity for re-interventions and low risk for preterm rupture of membranes. But intrauterine sonographic assessment of regression and prediction of postnatal need for sequestrectomy is less reliable.