Postnatal chest wall deformities after fetal thoracoamniotic shunting for congenital cystic adenomatoid malformation.
OBJECTIVE
Large macrocystic congenital cystic adenomatoid malformations (CCAMs) can be treated with thoracoamniotic (TA) shunting to reduce CCAM volume. Two CCAM fetuses treated with TA shunt had postnatal radiographic rib deformities.


METHODS
Retrospective review of prenatal TA shunting for large macrocystic CCAMs evaluated for the presence of rib deformities. Comparison groups not eligible for TA shunting included nonshunted CCAMs resected postnatally (group A) and size-matched nonshunted CCAMs resected postnatally (group B).


RESULTS
Chest wall abnormalities were identified in 77% of newborns ranging from severe concavity and fractures (in two fetuses shunted at 18 and 20 weeks of gestation) to rib thinning compared to comparison groups A and B. The severity of chest wall deformity correlated with earlier gestational age at shunting.


CONCLUSIONS
TA shunting at less than 21 weeks of gestational age may result in postnatal chest wall deformity. This observation should be discussed during counseling for this procedure.
Merchant
Aziz M
AM
Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, and Department of Surgery and Obstetrics/Gynecology, University of Pennsylvania, Philadelphia, Pa 19104-4399, USA.
Peranteau
William
W
Wilson
R Douglas
RD
Johnson
Mark P
MP
Bebbington
Michael W
MW
Hedrick
Holly L
HL
Flake
Alan W
AW
Adzick
N Scott
NS
D000328:Adult; D015615:Cystic Adenomatoid Malformation of Lung, Congenital / Q000000981:diagnostic imaging / Q000628:therapy*; D005260:Female; D005315:Fetal Diseases / Q000000981:diagnostic imaging / Q000628:therapy*; D046128:Fetal Therapies / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D011247:Pregnancy; D011256:Pregnancy Outcome; D011859:Radiography; D012189:Retrospective Studies; D035441:Thoracic Wall / Q000002:abnormalities* / Q000000981:diagnostic imaging