title: Retrospective review of thoracoamniotic shunting using a double-basket catheter for fetal chylothorax.
abstract: OBJECTIVE
  From a single-center retrospective cohort with fetal chylothorax, we evaluated the factors related to the decision to use shunting, poor prognostic factors, and reported shunting outcomes with a new double basket-catheter device.
  
  
  METHODS
  A retrospective single-center study was performed in 35 cases of fetal chylothorax.
  
  
  RESULTS
  There were 35 cases of chylothorax: 23 with hydrops and 12 without hydrops. Twenty-one procedures were performed on 15 fetuses (11 with hydrops) with a single shunt in 11, two shunts in 3 and four shunts in 1. All 12 nonhydropic cases survived. In 23 hydropic cases, overall survival rates with and without thoracoamniotic shunting were 46 and 33%, respectively. The mortality rates of fetal hydropic cases with and without ascites were 93 and 11%, respectively. Fetal ascites, progression of fetal hydrops, and premature delivery at <33 weeks were significant risk factors for a poor prognosis. Progression of polyhydramnios after shunting was also associated with a poor prognosis. Obstruction of the catheter was observed in 38%. There were no direct fetal deaths associated with shunting.
  
  
  CONCLUSIONS
  Thoracoamniotic shunting should be considered for pleural effusion before development of fetal hydrops, or at least before the appearance of fetal ascites. A double-basket catheter tends to be obstructive, but may be less invasive for fetuses.
authors.affiliation: Department of Perinatology and Gynecology, National Cerebral and Cardiovascular Center, Osaka, Japan. gomiyoshi0327@yahoo.co.jp
authors.forename: Takekazu
authors.initials: T
authors.lastname: Miyoshi
authors.forename: Shinji
authors.initials: S
authors.lastname: Katsuragi
authors.forename: Tomoaki
authors.initials: T
authors.lastname: Ikeda
authors.forename: Chinami
authors.initials: C
authors.lastname: Horiuchi
authors.forename: Kaoru
authors.initials: K
authors.lastname: Kawasaki
authors.forename: Chizuko A
authors.initials: CA
authors.lastname: Kamiya
authors.forename: Yoshihito
authors.initials: Y
authors.lastname: Sasaki
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Osato
authors.forename: Reiko
authors.initials: R
authors.lastname: Neki
authors.forename: Jun
authors.initials: J
authors.lastname: Yoshimatsu
mesh_terms: D000328:Adult; D002404:Catheterization; D002916:Chylothorax / Q000150:complications / Q000601:surgery*; D005260:Female; D005313:Fetal Death; D046128:Fetal Therapies / Q000295:instrumentation*; D006801:Humans; D015160:Hydrops Fetalis / Q000209:etiology / Q000517:prevention & control / Q000601:surgery*; D010996:Pleural Effusion / Q000601:surgery*; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D055815:Young Adult