title: Defining hydrops and indications for open fetal surgery for fetuses with lung masses and vascular tumors.
abstract: OBJECTIVE
  The aim of this study was to identify the most accurate prenatal predictors of outcomes and need for fetal surgery for fetuses with high-risk lung masses and vascular tumors.
  
  
  METHODS
  The records of all fetuses with high-risk lung mass (congenital cystic adenomatoid malformation-volume ratio > 1.6 or findings of hydrops) and vascular tumor evaluated between July 2001 and March 2011 were reviewed retrospectively. Hydrops was defined as accumulation of fluid in 2 or more compartments.
  
  
  RESULTS
  Of fetuses with high-risk lung mass, hydrops was identified in 46% (11/24). Fetuses with hydrops and an abnormal echocardiogram (n = 8) demonstrated poor survival without fetal surgery (13%) compared with 100% survival in fetuses with hydrops and a normal echocardiogram (n = 3; P = .02). Of 21 fetuses with vascular tumor (11 sacrococcygeal and 8 cervical teratomas; 2 hemangioendotheliomas), hydrops was identified in 29% and an abnormal echocardiogram in 57%. All fetuses with hydrops had an abnormal echocardiogram and either died (n = 5) or required fetal surgery (n = 1). However, all fetuses with abnormal echocardiograms alone (n = 7) survived without fetal intervention.
  
  
  CONCLUSIONS
  For fetuses with lung mass, an abnormal echocardiogram in the setting of hydrops is the best predictor of mortality and need for fetal surgery. For fetuses with vascular tumor, hydrops in the setting of high-output physiology best predicts demise and need for fetal surgery.
authors.affiliation: Texas Children's Fetal Center and Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA. dcass@bcm.edu
authors.forename: Darrell L
authors.initials: DL
authors.lastname: Cass
authors.forename: Oluyinka O
authors.initials: OO
authors.lastname: Olutoye
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Ayres
authors.forename: Kenneth J
authors.initials: KJ
authors.lastname: Moise
authors.forename: Carolyn A
authors.initials: CA
authors.lastname: Altman
authors.forename: Anthony
authors.initials: A
authors.lastname: Johnson
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Cassady
authors.forename: David A
authors.initials: DA
authors.lastname: Lazar
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Lee
authors.forename: M Regina L
authors.initials: MR
authors.lastname: Lantin
mesh_terms: D015615:Cystic Adenomatoid Malformation of Lung, Congenital / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*; D005260:Female; D005315:Fetal Diseases / Q000175:diagnosis* / Q000601:surgery*; D005333:Fetus / Q000601:surgery*; D006801:Humans; D015160:Hydrops Fetalis / Q000175:diagnosis* / Q000601:surgery*; D011247:Pregnancy; D011296:Prenatal Diagnosis; D012189:Retrospective Studies; D016216:Ultrasonography, Prenatal; D019043:Vascular Neoplasms / Q000150:complications / Q000175:diagnosis* / Q000601:surgery*