Fetal Medicine Unit, Division of Maternal-Fetal Medicine, Department of Obstetrics & Gynecology, Mount Sinai Hospital, Toronto, Ontario, Canada.
University of Toronto, Toronto, Ontario, Canada.
Fetal Diagn Ther. 2021;48(6):430-439. doi: 10.1159/000515694. Epub 2021 Apr 29.
Fetal thoraco-amniotic shunts (TASs) can dislodge in utero, migrating internally into the fetal thorax or externally into the amniotic cavity. Our objective was to evaluate the perinatal and long-term outcome of fetuses with TAS dislodgement and conduct a review of the literature.
This is a retrospective review of all TAS inserted for primary pleural effusions and macrocystic congenital pulmonary airway malformations (CPAMs) in a tertiary fetal medicine center (1991-2020). Antenatal history, procedural factors, and perinatal and long-term outcomes were reviewed in all fetuses with dislodged shunts and compared to fetuses with shunts that did not dislodge.
Of 211 TAS inserted at a mean gestational age of 27.8 weeks ± 5.47 (17.4-38.1 weeks), 187 (89%) were inserted for pleural effusions and 24 (11%) for macrocystic CPAMs. Shunts dislodged in 18 fetuses (8.5%), 17 (94%) of which were for pleural effusions. Shunts migrated into the chest wall/amniotic cavity or into the thorax among 7/18 (39%) and 11/18 (61%) fetuses, respectively. Eleven (61%) fetuses were initially hydropic, which resolved in 8 (72%) cases. Effusions were bilateral in 9 (50%), amnioreduction was required in 6 (33%), and fetal rotation in 8 cases (44%). Four (22%) fetuses underwent repeat shunting, 12 (67%) neonates required ventilatory support, and 2 (11%) neonates required chest tubes. There was no significant difference in technical factors or outcomes between infants with shunts that dislodged and those that did not. Among 11 intrathoracic shunts, 2 (18%) were removed postnatally and the remainder are in situ without any shunt-related or respiratory complications over a follow-up period of 9 months to 22 years.
TAS dislodged antenatally in 8.5% of fetuses, with 2/3 of shunts migrating into the thorax, and nearly 25% requiring re-shunting. Retained intrathoracic shunts were well tolerated and may not necessarily require surgical removal after birth.
胎儿胸-羊膜分流器（TAS）可能在宫内移位，向胎儿胸腔内或羊膜腔内内部迁移。我们的目的是评估 TAS 移位胎儿的围产期和长期结局，并对文献进行回顾。
这是对一家三级胎儿医学中心（1991-2020 年）插入的所有用于原发性胸腔积液和大囊型先天性肺气道畸形（CPAMs）的 TAS 进行的回顾性研究。对所有 TAS 移位胎儿的产前史、程序因素以及围产期和长期结局进行了回顾，并与 TAS 未移位胎儿进行了比较。
在平均妊娠 27.8 周±5.47（17.4-38.1 周）时插入了 211 个 TAS，其中 187 个（89%）用于胸腔积液，24 个（11%）用于大囊型 CPAMs。18 个胎儿（8.5%）的分流器移位，其中 17 个（94%）为胸腔积液。分流器分别向胸腔壁/羊膜腔或胸腔内迁移的胎儿分别为 7/18（39%）和 11/18（61%）。11 个（61%）胎儿最初为水肿，其中 8 例（72%）得到缓解。9 例（50%）胸腔积液为双侧，6 例（33%）需要羊水减少，8 例（44%）需要胎儿旋转。4 例（22%）胎儿再次分流，12 例（67%）新生儿需要通气支持，2 例（11%）新生儿需要胸腔引流管。在分流器移位和未移位的婴儿之间，技术因素或结局没有显著差异。在 11 例胸腔内分流器中，2 例（18%）在产后取出，其余的仍在原位，在 9 个月至 22 年的随访期间没有任何与分流器相关或呼吸相关的并发症。
TAS 在 8.5%的胎儿中产前移位，其中 2/3 的分流器向胸腔内迁移，近 25%需要再次分流。保留的胸腔内分流器耐受良好，出生后不一定需要手术取出。
