title: Successful in utero Percutaneous Fetoscopic Release of a Wrapped Pleuro-Amniotic Shunt around the Fetal Arm: Case Report and Review of the Literature.
abstract: OBJECTIVE
  Fetal pleural effusions are either primary or secondary to chromosomal or structural fetal abnormalities. In both cases, thoraco-amniotic shunts may be indicated to prevent life-threatening consequences. In this report, we describe a rare complication of shunts and successful in utero management of this complication. We also summarize the prior reports of shunt wrapping around fetal limbs and successful prenatal release of the shunts.
  
  
  METHODS
  Search including PubMed, MEDLINE and EMBASE databases from inception till November 2015 was conducted for cases with shunt entrapment around fetal limbs with or without prenatal management.
  
  
  RESULTS
  Four cases including our case have been reported in the literature with wrapping of shunts around fetal limbs. Three of these cases were successfully managed prenatally using different interventional and anesthetic techniques.
  
  
  CONCLUSIONS
  Prenatal shunts could be rarely complicated by wrapping of the shunt around fetal limbs with possible serious vascular and neurological consequences. Different techniques have been described for prenatal management of this condition. We describe a less invasive approach that could be done under local anesthesia in suitable cases.
authors.affiliation: Department of Obstetrics and Gynecology, Baylor College of Medicine, and Texas Children's Fetal Center, Houston, Tex., USA.
authors.forename: Ahmed A
authors.initials: AA
authors.lastname: Nassr
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Ruano
authors.forename: Jimmy
authors.initials: J
authors.lastname: Espinoza
authors.forename: Alireza A
authors.initials: AA
authors.lastname: Shamshirsaz
mesh_terms: D000328:Adult; D001132:Arm / Q000000981:diagnostic imaging* / Q000601:surgery; D005260:Female; D005332:Fetoscopy / Q000379:methods*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D010996:Pleural Effusion / Q000000981:diagnostic imaging* / Q000601:surgery; D011247:Pregnancy; D016216:Ultrasonography, Prenatal / Q000379:methods*; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*
keywords: Fetoscopy; Prenatal therapy; Thoraco-amniotic shunt