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Background: Fetal balloon atrial septoplasty (BAS) is performed through the restrictive foramen ovale in fetal cases with established hypoplastic left heart syndrome (HLHS) and an intact or highly restrictive atrial septum (RAS). Methods: In the current report, we present a case of high position BAS in a fetus with HLHS/RAS. Results: Echocardiography confirmed an adequate atrial opening above the foramen ovale and fetal pleural effusion resolved spontaneously 1 day after the procedure. Conclusion: To the best of our knowledge, the creation of a high position hole in the thinner part of the atrial septum, instead of the restrictive tiny hole, has not been reported in fetal cases with HLHS/RAS. Keywords: Congenital heart disease, Fetal balloon atrial septoplasty, Hypoplastic left heart syndrome, Intact or highly restrictive atrial septum

Introduction: The aim of this study is to evaluate long-term neurodevelopmental and respiratory outcome after fetal therapy for fetal pleural effusion, congenital cystic adenomatoid malformation, and bronchopulmonary sequestration. Methods: Children ≥18 months of age underwent an assessment of neurologic, motor, and cognitive development. Medical records were reviewed to determine respiratory outcome. Behavioral outcome was assessed using the Child Behavioral Checklist. Results: Between 2001 and 2016, 63 fetuses with fetal hydrops secondary to thoracic abnormalities were treated at our center. Overall perinatal survival was 64% (40/63). Twenty-six children were included for follow-up (median age 55 months). Severe neurodevelopmental impairment (NDI) was detected in 15% (4/26). Three out of 4 children with severe NDI had associated causes contributing to the impairment. Overall adverse outcome, including perinatal mortality or NDI, was 55% (27/49). Fifteen percent (4/26) had severe respiratory sequelae. Parents did not report more behavioral problems than Dutch norms. Discussion: Our results suggest that severe NDI in this specific high-risk cohort occurs in 15%, which is above the range of the incidence of NDI reported in case series treated with other fetal therapies (5–10%). Large multicenter studies and an international web-based registry are warranted to prospectively gather outcome data at fixed time points.

Despite the rapid advances in fetal medicine and pediatric surgery, congenital chylothoraces have an associated mortality of 22–65% and an increased morbidity resulting from pulmonary hypoplasia, severe infections secondary to immune globulin deficiencies, protein malnutrition, and coagulopathy. While the mainstay of therapy is medical management, large volume chylothoraces often require surgical management. In both the prenatal and postnatal periods, the recommended management of congenital chylothoraces is still controversial. We present a case of a prenatally diagnosed large chylothorax associated with a cervical lymphatic malformation. In our patient, the chylothorax persisted despite optimal postnatal medical management with drainage by tube thoracostomy, TPN, and octreotide. Adjuvant therapies included sirolimus and sclerotherapy directed toward the treatment of the macrocystic lymphatic malformation. We report the first case of a persistent congenital chylothorax associated with a lymphatic malformation successfully treated with thoracoscopic talc pleurodesis and sclerotherapy.

Fetal pleural effusion is a rare abnormality that results from accumulation of fluid in the chest cavity. It can be classified as primary fetal hydrothorax and secondary fetal hydrothorax. The underlying causes of pleural effusion are still unknown, and the current treatment strategies are mainly based on symptoms. The prognosis of fetal pleural effusion varies significantly, ranging from spontaneous resolution to perinatal death. Recent advances in prenatal diagnostic methods and treatment such as thoracoamniotic shunting have significantly improved the survival rates for patients with or without hydrops.

Isolated fetal pleural effusion is a rare condition with high mortality. When there are no other findings of hydropsfetalis or documented etiology such as inflammatory, iatrogenic or cardiac problems exist, isolated pleural effusion is considered. We present a rare case of isolated bilateral fetal pleural effusion diagnosed prenatally on ultrasonography. Nepal Journal of Medical Sciences | Volume 03 | Number 01 | January-June 2014 | Page 76-78 DOI: http://dx.doi.org/10.3126/njms.v3i1.10367

Glomuvenous malformations are hereditary vascular anomalies, usually without extracutaneous involvement. We report two cases of extensive thoracic plaque-type glomuvenous malformation in newborns who had previously been diagnosed in utero with pleural effusion and ascites, suggesting a pathogenic link between the two conditions.

Isolated fetal pleural effusion is rare. A good outcome of 100% survival rate can be expected in cases of spontaneous resolution of the anomaly in utero. If resolved, they are usually not associated with any structural abnormality. We report a case of diaphragmatic hernia presenting as isolated unilateral pleural effusion which resolved spontaneously. This has important implications for the management of isolated fetal pleural effusion.

A case of pleural effusion, diagnosed by ultrasound in the second trimester, underwent spontaneous resolution without adverse effect on lung development. Optimal management has not been defined; because the natural history of fetal pleural effusion is unknown, observation with serial ultrasound is an alternative to in utero therapy.

This prospective observational study aimed to determine the frequency of pleural effusion in early pregnancy, and to learn whether it is associated with chromosomal abnormalities or a poor pregnancy outcome. The study group included 965 viable singleton pregnancies, confirmed by ultrasound at 7 to 10 weeks gestation. Serial studies were carried out if initial transvaginal sonography demonstrated pleural effusion. A total of 1063 pregnancies, excluding therapeutic abortions, were evaluated at 2 obstetric clinics. There were 135 spontaneous abortions (13%) in this series. Ultrasonography at the initial visit disclosed pleural effusion in 12 of 965 viable pregnancies (1.2%). All 14 effusions (2 were added from a previous report) were bilateral. Embryonic or fetal death occurred in 12 cases (86%) by 14 weeks gestation. Karyotypic abnormalities were present in 9 of 11 cases in which chorionic villi were sampled; 9 were 45,X. All but 2 of 14 pleural effusions resolved spontaneously by 9 to 12 weeks gestation along with cardiac activity. The 2 cases in which cardiac activity persisted ended in miscarriage at 9 weeks. In 3 cases, a viable pregnancy continued for 2 weeks or longer after pleural effusion had resolved spontaneously. The sonographic finding of embryonic/fetal pleural effusion in the first trimester reliably predicts poor pregnancy outcomes, notably karyotype abnormality and miscarriage.

DOI: http://dx.doi.org/10.3126/njog.v4i2.5050 NJOG 2010 Jan-Feb; 4(2): 56-58

A case of fetal pleural effusion detected by ultrasound at 33 weeks of gestation is described.