Fetal surgery of pulmonary malformations (congenital pulmonary airway malformation and bronchopulmonary sequestration complicated by massive pleural effusion): review article

Congenital malformations of the respiratory system are rare non-chromosomal pathology (4.01-4.15‰). But, despite it, the questions of fetal surgery of these anomalies remain relevant, because, firstly, they are often combined with other malformations, and secondly, in complicated cases, the death of fetus or newborn can occur. This article describes the structure of lesions, diagnostic problems and intrauterine surgical treatment of congenital pulmonary airway malformation and bronchopulmonary sequestration complicated by massive pleural effusion. Laser ablation of the feeding artery and thoracoamniotic shunting are described in a comparative aspect as the principle, the most common in the world, methods of surgical treatment. Based on different studies, which were described and analised in this article, laser ablation is recognized as a modern, radical and highly effective method that provides a higher rate of live birth, surviving (about 100% versus to 59-68% during shunting), allows to increase the gestational age (up to 39.1 weeks), and reduces the rate of postnatal surgeries ( up to 18.2-20%), as well as the need for intensive care or oxygen support of newborns. Laser ablation in 91.7% of cases completely stops the blood supply to the lung lesion and in almost all described cases leads to its further necrosis and lysis in postnatal period of newborn’s life.

fetal surgery, congenital lung malformation, bronchopulmonary sequestration, fetal hydrothorax, laser ablation, thoracoamniotic shunting