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Sequential Minimally Invasive Fetal Interventions for Two Life-Threatening Conditions: A Novel Approach.

Rodrigo Ruano1,2, Eniola R Ibirogba3, Michelle A Wyatt3

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Summary

Sequential in utero interventions successfully treated two severe fetal anomalies: bronchopulmonary sequestration and congenital diaphragmatic hernia. This novel approach offers hope for complex cases, improving neonatal outcomes.

Keywords:
Bronchopulmonary sequestration fetoscopyCongenital diaphragmatic herniaFetal endoscopic tracheal occlusionFetal lung mass

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Area of Science:

  • Fetal Medicine
  • Pediatric Surgery
  • Congenital Anomalies

Background:

  • In utero interventions aim to improve outcomes for fetuses with major congenital anomalies.
  • Treating multiple anomalies within a single fetus in utero has not been previously documented.

Observation:

  • A fetus presented with both a large intralobar bronchopulmonary sequestration (BPS) and severe congenital diaphragmatic hernia (CDH).
  • The BPS caused mediastinal shift and hydrops, while the CDH led to poor lung development.

Findings:

  • Ultrasound-guided ablation of the BPS feeding vessel led to tumor regression.
  • Fetal endoscopic tracheal occlusion was performed to enhance lung growth due to CDH.
  • The infant underwent successful postnatal repair and was discharged on room air.

Implications:

  • Sequential in utero interventions can address multiple severe fetal anomalies simultaneously.
  • This approach may be a viable option for cases with high morbidity and mortality.
  • Further research is needed to validate this therapeutic strategy.