PT  - JOURNAL ARTICLE
AU  - Joel Reiter
AU  - Andrew A. Colin
AU  - Eftichia V. Kontopoulos
AU  - Shahriar Shahzeidi
AU  - Ruben A. Quintero
TI  - Fetal bronchoscopy for treatment of congenital pulmonary anomalies
DP  - 2013 Sep 01
TA  - European Respiratory Journal
PG  - 5016
VI  - 42
IP  - Suppl 57
4099  - http://erj.ersjournals.com/content/42/Suppl_57/5016.short
4100  - http://erj.ersjournals.com/content/42/Suppl_57/5016.full
SO  - Eur Respir J2013 Sep 01; 42
AB  - Fetal bronchoscopies (FB) to evaluate/treat suspected bronchial atresia deemed inconsistent with life are reported.Patient 1Previously published (Quintero, J. et al. Matern Fetal Neonatal Med 2012;25:2354). Fetal ultrasound (US) and intrauterine MRI at 28 wGA revealed a left hemithorax mass putatively caused by bronchial atresia, mediastinal shift with compressed hypoplastic contralateral (Rt) lung. FB was performed at 31 wGA with continuous saline infusion. Intraoperative US showed real time expansion of all lung segments with subsequent sustained growth relative to the mass till birth. Resection of the lesion at 11 mo revealed CCAM type 3 with extralobar pulmonary sequestration.Patient 2Seen at 30 wGA with similar presentation, US and MRI findings. FB revealed a narrowed orifice to the LUL. Intraoperative US revealed no bubbles in the mass, but positive in peripheral Lt and entire Rt lung. Only minor improvement occurred until delivery at 40 wGA. Perinatal CT-angio demonstrated LUL congenital lobar emphysema (CLE) confirmed by pathology after resection on DOL 8. Follow-up was unremarkable.Conclusion:· The improvement observed during the intervention and maintained in Pt 1 was interpreted as establishment of airway patency. Restoration of amniotic fluid flow to lung periphery was deemed the key element providing an internal template for the developing lung· While airway patency was established in Pt 2, the differential growth patterns of varied congenital anomalies may underlie the different outcomes· FB should be reserved for cases where extrauterine viability is deemed unlikely· Further experience with congenital anomalies is needed to establish reliable predictors of outcome of this novel intervention.