title: EXIT-to-resection for fetuses with large lung masses and persistent mediastinal compression near birth.
abstract: OBJECTIVE
  To identify prenatal diagnostic features that will help select fetuses with lung masses (LM) who may benefit from ex-utero intrapartum treatment (EXIT procedure) as the preferred mode of delivery.
  
  
  METHODS
  The CCAM-volume ratio (CVR), fetal treatment, and outcomes of all fetuses with LM evaluated between 2001 and 2011 were reviewed retrospectively. Fetuses with hydrops or CVR>1.6 were classified as high risk. Indications for fetal interventions included hydrops and heart failure, and indication for EXIT-to-resection was the finding of persistent mediastinal compression (PMC) near birth.
  
  
  RESULTS
  Of 110 fetuses evaluated for LM, 78 were classified as low-risk. No fetus in this group had PMC near birth and none required perinatal treatment. Of 32 high-risk fetuses, 8 developed heart failure of which 4 survived (3 following fetal surgery). Nine high-risk fetuses with no PMC near birth were asymptomatic postnatally and treated electively. Sixteen high-risk fetuses had PMC near birth. All 9 babies with PMC treated with EXIT-to-resection did well with discharge at a median of 10 days post-operatively. All 7 fetuses treated without an EXIT developed respiratory distress following birth requiring an urgent operation; 2 died.
  
  
  CONCLUSIONS
  The EXIT-to-resection procedure is a favorable delivery approach for those fetuses with large LM and PMC near birth.
authors: Texas Children's Fetal Center and Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX 77030, USA. dcass@bcm.edu
authors: Darrell L
authors: DL
authors: Cass
authors: Oluyinka O
authors: OO
authors: Olutoye
authors: Christopher I
authors: CI
authors: Cassady
authors: Irving J
authors: IJ
authors: Zamora
authors: R Todd
authors: RT
authors: Ivey
authors: Nancy A
authors: NA
authors: Ayres
authors: Olutoyin A
authors: OA
authors: Olutoye
authors: Timothy C
authors: TC
authors: Lee
mesh_terms: D000293:Adolescent; D000328:Adult; D002585:Cesarean Section; D005260:Female; D006801:Humans; D015160:Hydrops Fetalis / Q000175:diagnosis / Q000209:etiology; D007231:Infant, Newborn; D008171:Lung Diseases / Q000150:complications / Q000151:congenital / Q000175:diagnosis / Q000601:surgery*; D008297:Male; D008477:Mediastinal Diseases / Q000175:diagnosis / Q000209:etiology*; D011013:Pneumonectomy / Q000379:methods*; D011247:Pregnancy; D011296:Prenatal Diagnosis; D015619:Respiratory System Abnormalities / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D018570:Risk Assessment; D016896:Treatment Outcome; D055815:Young Adult