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Hemodynamic evaluation of a prenatal thoracoamniotic shunt for fetal pleural effusion
Hisashi Yonemoto1, Shigeru Itoh, Yasushi Nakamura
1Department of Obstetrics and Gynecology, Juntendo University School of Medicine, Japan. yonemoto@med.juntendo.ac.jp
Insights
A thoracoamniotic shunt significantly improved fetal hemodynamics by reducing preload index and thoracic edema in fetuses with pleural effusion (PE). This intervention enhanced lung development, indicating its efficacy in managing fetal PE.
Area of Science:
- Fetal Medicine
- Cardiovascular Physiology
- Neonatal Surgery
Background:
- Pleural effusion (PE) in fetuses can lead to significant hemodynamic compromise.
- Assessing fetal hemodynamics is crucial for managing conditions like PE.
- Thoracoamniotic shunting is a potential intervention for fetal PE.
Purpose of the Study:
- To evaluate the hemodynamic efficacy of thoracoamniotic shunts in treating fetal pleural effusion.
- To assess changes in preload index, aortic flow, thoracic edema, and lung-to-thorax ratio post-shunting.
Main Methods:
- Ultrasound assessment of preload index (PLI) in the inferior vena cava (IVC) and maximal flow velocity of the descending aorta (VAomax).
- Measurement of thoracic skin edema and lung-to-thorax (L/T) transverse area ratio.
- Evaluation in 5 fetuses with PE before and after thoracoamniotic shunt placement.
Main Results:
- Significant reduction in PLI (0.488 to 0.348) and thoracic edema (15.3 mm to 9.0 mm) post-shunt placement (P < 0.05).
- Significant increase in L/T ratio (0.220 to 0.260) post-shunting (P < 0.01).
- No significant change in VAomax observed (P = 0.16).
Conclusions:
- Thoracoamniotic shunting effectively improves fetal hemodynamics in cases of PE.
- The procedure leads to significant improvements in preload and thoracic fluid accumulation.
- Shunting positively impacts fetal lung development indicators.
Aims:
To evaluate the efficacy of a thoracoamniotic shunt for the treatment of pleural effusion (PE) in the view of hemodynamics.
Methods:
The preload index (PLI) in the inferior vena cava (IVC), the maximal flow velocity of the descending aorta (VAomax), skin edema on the thorax and the ratio of lung to the thorax transverse area (L/T) as measured by ultrasound were evaluated before and after thoracoamniotic shunt placement for 5 fetuses with PE.
Results:
The PLI and skin edema on the thorax decreased significantly after shunt placement compared to before shunt placement (PLI before: 0.488 +/- 0.036, after: 0.348 +/- 0.043, P < 0.05; edema before: 15.3 +/- 2.06 mm, after: 9.00 +/- 0.63 mm, P < 0.05). Furthermore, the L/T increased significantly after shunt placement compared to before (before: 0.220 +/- 0.013, after: 0.260 +/- 0.011, P < 0.01). No significant difference in VAomax was seen between before and after shunt placement (before: 101.5 +/ -6.39 cm/s, after: 10.7.6 +/ -5.41 cm/s, P = 0.16).
Conclusions:
The shunt for PE improved PLI especially in the fetal hemodynamics significantly.
