Clinical evaluation of In-utero fetal shunt operation using basket-shaped catheter: 5-year experience at Asan Medical Center

Won, Hye Sung; Hwang, Jong Yun; Kim, Sun Kwon; Jung, Eui; Oh, Jee Young; Shim, Jae Yoon; Lee, Pyl Ryang; Kim, Ahm

Abstract

OBJECTIVE
To evaluate the clinical outcomes of In-utero fetal shunt operations at Asan Medical Center.
METHODS
We reviewed the medical records of 33 occasions in 28 pregnancies that underwent intrauterine shunt operations between December, 1998 and April, 2004. Fetal shunt operations were considered for cases of hydrothorax (N=10), congenital cystic adenomatoid malformation type I (CCAM Type I)(N=5), lower urinary tract obstruction (N=6), severe hydronephrosis (N=7) and severe fetal ascites (N=5). Selection criteria of fetus for the shunt operation required normal karyotype and negative infection. Basket-shaped catheter was used for the procedure. Kruskal-Wallis test, Mann-Whitney U test, and Chi-Square test were used for statistical analysis. P<0.05 was considered statistically significant.
RESULTS
In CCAM Type I, the mean gestational age was 25.6+/-4.0 weeks at diagnosis, 26.0+/-4.4 weeks at shunt operation and 36.6+/-3.9 weeks at delivery. Perinatal survival rate was 66.7% (2/3). In hydrothorax, the mean gestational age was 26.7+/-3.3 weeks at diagnosis, 27.3+/-3.3 weeks at shunt operation and 34.9+/-3.0 weeks at delivery. Perinatal survival rate was 80.0% (4/5). In lower urinary tract obstruction, the mean gestational age was 18.5+/-3.7 weeks at diagnosis, 19.6+/-3.5 weeks at shunt operation and 34.5+/-2.9 weeks at delivery. Perinatal survival rate was 80.0% (2/3). In hydronephrosis, the mean gestational age was 25.3+/-5.3 weeks at diagnosis, 27.4+/-5.3 weeks at shunt operation and 36.9+/-2.2 weeks at delivery. Perinatal survival rate was 83.3% (5/6). In ascites, the mean gestational age was 29.6+/-3.9 weeks at diagnosis, 29.9+/-3.8 weeks at shunt operation and 34.1+/-3.0 weeks at delivery. Perinatal survival rate was 100.0% (5/5). Complications occurred in 48.5% (16/33) of the cases. The most common complication was shunt dislodgement (N=7).
CONCLUSION
In-utero fetal shunt operation should be considered as a treatment option for hydrothorax, CCAM type I, lower urinary tract obstruction, severe hydronephrosis and severe ascites with a significant risk for pulmonary hypoplasia.