Postnatal Outcomes and Surgical Implications of Somatex™ Thoracoamniotic Shunting for CPAM: A Multicenter Experience

Intrauterine thoracoamniotic shunting in fetuses with congenital pulmonary airway malformation (CPAM) was first described using Cook™ or Rocket™ shunts. With the availability of the Somatex™ intrauterine shunt, a new device with the supposed advantages of less invasive placement and less frequent dislocations, pediatric surgeons and neonatologists are increasingly confronted with a new cohort of patients. Data on postnatal findings and the impact on surgical management are scarce.We conducted a multicenter retrospective study of all children born after prenatal treatment with a Somatex™ thoracoamniotic shunt for suspected CPAM. We analyzed the clinical and respiratory conditions of the children at birth as well as shunt locations, removal procedures, and timing of surgery.Twelve patients were included. 8/12 patients presented postnatally with pneumothorax, necessitating in all cases the placement of a chest tube. In 6/12 patients, the removal of the Somatex™ shunt had to be done surgically, bedside removal was possible in 5 patients. One patient was born without the shunt due to intrauterine dislocation. All patients were operated on using a muscle-sparing thoracotomy, at ages ranging from 1 to 42 days; only one could be discharged before surgery. One patient underwent emergency surgery. With a median follow-up of 19 months, 11/12 patients survived.Despite the small number of patients and the retrospective aspect of this study, our observations showed that intrauterine treatment of CPAM with the Somatex™ shunt is frequently associated with postnatal complications. Neonatologists and pediatric surgeons must be aware of the high rate of pneumothorax and the presumable necessity of early surgical intervention.