title: Thoracoamniotic Shunts in Macrocystic Lung Lesions: Case Series and Review of the Literature.
abstract: OBJECTIVE
  To evaluate the efficiency of thoracoamniotic shunts for drainage of macrocystic-type congenital cystic adenomatoid malformation (CCAM).
  
  
  METHODS
  This was a retrospective study of 12 fetuses with a large thoracic cyst treated with thoracoamniotic shunting between 2004 and 2014 in a tertiary fetal therapy center. Medline was searched to identify cases of CCAM treated with thoracoamniotic shunting.
  
  
  RESULTS
  In all cases the thoracic cyst was associated with major mediastinal shift, the CCAM volume ratio (CVR) was >1.6, and in eight cases there was associated hydrops. Shunt insertion was successfully carried out in all cases at a median gestational age of 24 weeks (range 18-34). In 10 cases there was live birth at a median age of 38 weeks (range 35-41), but in two hydropic fetuses there was intrauterine death. A literature search identified a total of 98 fetuses with CCAM treated with thoracoamniotic shunting between 1987 and 2016. In the combined data from the previous and the current study, the survival rate was 77% (53 of 69) for hydropic and 90% (37 of 41) for nonhydropic fetuses.
  
  
  CONCLUSIONS
  The role of thoracoamniotic shunting in macrocystic lung lesions associated with hydrops is well accepted. Intrauterine intervention is also likely to be beneficial in the subgroup of nonhydropic fetuses with a CVR >1.6.
authors.affiliation: Department of Gynecology, Fertility and Fetal Therapy, Polish Mother's Memorial Hospital Research Institute, Lodz, Poland.
authors.forename: Magdalena
authors.initials: M
authors.lastname: Litwińska
authors.forename: Ewelina
authors.initials: E
authors.lastname: Litwińska
authors.forename: Katarzyna
authors.initials: K
authors.lastname: Janiak
authors.forename: Anna
authors.initials: A
authors.lastname: Piaseczna-Piotrowska
authors.forename: Ewa
authors.initials: E
authors.lastname: Gulczyńska
authors.forename: Krzysztof
authors.initials: K
authors.lastname: Szaflik
mesh_terms: D002404:Catheterization / Q000295:instrumentation / Q000379:methods; D015615:Cystic Adenomatoid Malformation of Lung, Congenital / Q000000981:diagnostic imaging* / Q000601:surgery*; D005260:Female; D006801:Humans; D011247:Pregnancy; D012189:Retrospective Studies; D013908:Thoracotomy / Q000295:instrumentation / Q000379:methods*; D016216:Ultrasonography, Prenatal / Q000379:methods*
keywords: Congenital cystic adenomatoid malformation; Fetal therapy; Thoracoamniotic shunt