Cardiovascular Effects of a Thoracoamniotic Shunt in a Fetus Affected by Isolated Right Congenital Diaphragmatic Hernia and Hydrops

TL;DR

A thoracoamniotic shunt was used in a fetus with a right diaphragmatic hernia and hydrops, but it did not improve survival despite some initial cardiac improvements.

Contribution

The study provides insights into the cardiovascular effects of thoracoamniotic shunting in a rare and severe fetal condition.

Findings

Initial shunt placement reduced edema and improved combined cardiac output Z-scores.

Cardiac function worsened two weeks later, suggesting possible shunt occlusion.

The newborn died due to pulmonary hypertension and respiratory insufficiency despite intensive care.

Abstract

A thoracoamniotic shunt was placed in a fetus affected by a right congenital diaphragmatic hernia (RCDH) complicated by voluminous nonimmune hydrops (NIH) at 30 weeks of gestation. The fetus showed congestive cardiac failure with a combined cardiac output (CCO) of 460.7 ml/min (Z-score: -1.2). After seven days, no edema, ascites, or pleural effusion was present. CCO increased significantly, reaching a Z-score of -0.2, as well as right and left cardiac output (Z-scores: -0.3 and -0.8, respectively). Two weeks later, the cardiac function and the ascites got worse despite the correct shunt placement, suggesting a possible occlusion. At 33 weeks, a C-section was performed due to labor in breech presentation. Despite the intensive care provided, the newborn died due to pulmonary hypertension and respiratory insufficiency. The thoracoamniotic shunt’s effect on fetal circulation and the mechanisms of NIH in the event of RCDH are still unclear. Due to the high mortality rate of this condition and its poorer outcomes compared to left-sided defects, shunting cannot be considered an efficient attempt to improve fetal and neonatal survival rates to date. A close relationship between the amount of lymphatic effacement and cardiac function is clear, but further studies are needed to provide more information about this severe condition and its treatment.

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