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https://www.readbyqxmd.com/read/28434005/chorioamniotic-membrane-separation-after-fetoscopic-laser-photocoagulation
#1
Mayumi Takano, Masahiko Nakata, Susumu Murata, Masahiro Sumie, Mineto Morita
INTRODUCTION: This study aimed to investigate the risk factors, incidence, and influence on the perinatal outcome of chorioamniotic membrane separation (CMS) after fetoscopic laser photocoagulation (FLP). MATERIAL AND METHODS: This retrospective study included 312 women who underwent FLP for twin-to-twin transfusion syndrome (TTTS). Clinical records were used to review obstetrical examinations, complications, operative data, ultrasonographic findings, and perinatal and neonatal follow-up data in all patients...
April 22, 2017: Fetal Diagnosis and Therapy
https://www.readbyqxmd.com/read/28428904/salvage-of-necrotic-appearing-limb-after-in-utero-endoscopic-lysis-of-constriction-bands
#2
M Abdel-Sattar, A Chon, B Chen, W Burkhalter, R H Chmait
We report a case of amniotic band syndrome complicated by constriction bands and marked distal swelling of both lower extremities. Color Doppler interrogation of the right lower extremity revealed complete lack of blood flow below the level of the constriction. Upon fetoscopic survey, the right lower extremity beyond the constriction band appeared dusky red and discolored with desquamation, consistent with a necrotic appearance. The constriction bands were cut in utero using endoshears, thereby allowing restoration of blood flow on postoperative day 1...
April 2017: American Journal of Perinatology Reports
https://www.readbyqxmd.com/read/28403975/-fetoscopic-laser-coagulation-in-200%C3%A2-consecutive-monochorionic-pregnancies-with-twin-twin-transfusion-syndrome
#3
L Lecointre, N Sananès, A S Weingertner, A Gaudineau, C Akladios, V Cavillon, B Langer, R Favre
OBJECTIVES: To report preoperative data, surgical characteristics, complications and perinatal outcome of twin-twin transfusion syndrome (TTTS) managed with laser ablation surgery, to analyze predictors of neonatal survival and to compare the 100 most recent cases with the older 100. MATERIALS AND METHODS: Observational cohort moncentric study of 200 cases of TTTS consecutively treated with fetoscopic laser coagulation between January 2004 and December 2014...
February 2017: J Gynecol Obstet Hum Reprod
https://www.readbyqxmd.com/read/28370497/cardiac-pathophysiology-in-twin-twin-transfusion-syndrome-new-insights-into-its-evolution
#4
Christoph Wohlmuth, David Boudreaux, Kenneth J Moise, Anthony Johnson, Ramesha Papanna, Michael Bebbington, Helena M Gardiner
OBJECTIVES: In twin-twin transfusion syndrome (TTTS) unbalanced transfer of vasoactive mediators and fluid from the 'donor' to the 'recipient' alters cardiovascular function. We evaluated cardiac function in 145 monochorionic-diamniotic (MCDA) pregnancies with and without TTTS. METHODS: Echocardiography was performed in uncomplicated MCDA, n = 26; TTTS stage I+II, n = 61; TTTS stage III+IV, n = 58, before selective fetoscopic laser photocoagulation (SFLP) in TTTS, and afterwards in 41 (34%) at a mean of 1...
March 31, 2017: Ultrasound in Obstetrics & Gynecology
https://www.readbyqxmd.com/read/28335669/the-experience-of-modified-sequential-selective-laser-photocoagulation-of-communicating-vessels-technique-for-twin-twin-transfusion-syndrome
#5
Susumu Murata, Mayumi Takano, Yukiko Kagawa, Masahiro Sumie, Masahiko Nakata
OBJECTIVE: Fetoscopic laser photocoagulation of vascular anastomoses is the essential choice in twin-twin transfusion syndrome (TTTS). We proposed that the modified sequential selective laser photocoagulation of communicating vessels (modified SQLPCV) to clarify the perinatal outcomes in TTTS. METHODS: The modified SQLPCV was designed with the following order: 1, artery-to-artery anastomoses; 2, venous-to-venous anastomoses; 3, artery-to-venous anastomoses from donor to recipient; and 4, artery-to-venous anastomoses from recipient to donor...
March 23, 2017: Journal of Maternal-fetal & Neonatal Medicine
https://www.readbyqxmd.com/read/28287588/medical-grade-sterilizable-target-for-fluid-immersed-fetoscope-optical-distortion-calibration
#6
Daniil I Nikitichev, Dzhoshkun I Shakir, François Chadebecq, Marcel Tella, Jan Deprest, Danail Stoyanov, Sébastien Ourselin, Tom Vercauteren
We have developed a calibration target for use with fluid-immersed endoscopes within the context of the GIFT-Surg (Guided Instrumentation for Fetal Therapy and Surgery) project. One of the aims of this project is to engineer novel, real-time image processing methods for intra-operative use in the treatment of congenital birth defects, such as spina bifida and the twin-to-twin transfusion syndrome. The developed target allows for the sterility-preserving optical distortion calibration of endoscopes within a few minutes...
February 23, 2017: Journal of Visualized Experiments: JoVE
https://www.readbyqxmd.com/read/28281301/doppler-assessment-of-patients-with-twin-to-twin-transfusion-syndrome-and-survival-following-fetoscopic-laser-surgery
#7
Enrique Gil Guevara, Andrea Pazos, Otilia Gonzalez, Pilar Carretero, Francisca S Molina
OBJECTIVE: To investigate fetal-survival rates following laser surgery for twin-to-twin transfusion syndrome (TTTS) and the impact of Doppler analysis. METHODS: The present retrospective single-center study included data from patients with pregnancies exhibiting TTTS treated with fetoscopic laser surgery between January 1, 2007, and December 31, 2016. Perinatal outcomes were examined and variables were compared between the donor and recipient fetuses that survived and died, respectively...
March 9, 2017: International Journal of Gynaecology and Obstetrics
https://www.readbyqxmd.com/read/28277363/fetoscopic-open-neural-tube-defect-repair-development-and-refinement-of-a-two-port-carbon-dioxide-insufflation-technique
#8
Michael A Belfort, William E Whitehead, Alireza A Shamshirsaz, Zhoobin H Bateni, Oluyinka O Olutoye, Olutoyin A Olutoye, David G Mann, Jimmy Espinoza, Erin Williams, Timothy C Lee, Sundeep G Keswani, Nancy Ayres, Christopher I Cassady, Amy R Mehollin-Ray, Magdalena Sanz Cortes, Elena Carreras, Jose L Peiro, Rodrigo Ruano, Darrell L Cass
OBJECTIVE: To describe development of a two-port fetoscopic technique for spina bifida repair in the exteriorized, carbon dioxide-filled uterus and report early results of two cohorts of patients: the first 15 treated with an iterative technique and the latter 13 with a standardized technique. METHODS: This was a retrospective cohort study (2014-2016). All patients met Management of Myelomeningocele Study selection criteria. The intraoperative approach was iterative in the first 15 patients and was then standardized...
April 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28272225/a-new-method-for-selective-reduction-in-trap-sequence-with-a-contraindication-to-fetoscopic-surgery-a-case-report
#9
Qi Li, Xin-Hua Wu, Wei-She Zhang
RATIONALE: The preferred method for multifetal pregnancy reduction (MFPR) is a transabdominal intrathoracic or intracranial injection of potassium chloride (KCl). However, in monochorionic multiple pregnancies (MMPs), especially in monoamnionic multifetal pregnancies, selective feticide by this method is often associated with miscarriage of the remaining fetuses. Selective fetal reduction in MMPs by blood flow ablation using radiofrequency ablation or fetoscopic laser surgery may improve survival of the remaining fetus...
March 2017: Medicine (Baltimore)
https://www.readbyqxmd.com/read/28267443/balloon-removal-after-fetoscopic-endoluminal-tracheal-occlusion-for-congenital-diaphragmatic-hernia
#10
Julio A Jiménez, Elisenda Eixarch, Philip DeKoninck, João R Bennini, Roland Devlieger, Cleisson F Peralta, Eduard Gratacos, Jan Deprest
BACKGROUND: Isolated congenital diaphragmatic hernia defect allows viscera to herniate into the chest, competing for space with the developing lungs. At birth, pulmonary hypoplasia leads to respiratory insufficiency and persistent pulmonary hypertension that is lethal in up to 30% of patients. Antenatal measurement of lung size and liver herniation can predict survival after birth. Prenatal intervention aims at stimulating lung development, clinically achieved by percutaneous fetal endoscopic tracheal occlusion under local anesthesia...
March 3, 2017: American Journal of Obstetrics and Gynecology
https://www.readbyqxmd.com/read/28244950/anesthetic-management-for-percutaneous-minimally-invasive-fetoscopic-surgery-of-spina-bifida-aperta-a-retrospective-descriptive-report-of-clinical-experience
#11
Christoph Arens, Christian Koch, Mirko Veit, Robert Steven Greenberg, Christoph Lichtenstern, Markus Alexander Weigand, Anastasiia Khaleeva, Rainer Schuerg, Thomas Kohl
Minimally invasive fetoscopic surgery for spina bifida aperta is a new therapeutic approach to preserve neurologic function by protecting exposed neural tissue. The anesthetic management is of paramount importance for the success of the procedure. Therefore, our protocol was developed with particular attention to safe and adequate maternal and fetal anesthesia, sufficient uterine relaxation as well as prevention of pulmonary edema, placental abruption, and spontaneous labor. As illustrated by this retrospective analysis of 61 cases, these goals can be reliably achieved...
February 24, 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28196661/pediatric-medical-device-development-by-surgeons-via-capstone-engineering-design-programs
#12
Bryan S Sack, Rodolfo A Elizondo, Gene O Huang, Nicolette Janzen, Jimmy Espinoza, Magdalena Sanz-Cortes, Jennifer E Dietrich, Julie Hakim, Eric Richardson, Maria Oden, John Hanks, Balakrishna Haridas, James F Hury, Chester J Koh
BACKGROUND: There is a need for pediatric medical devices that accommodate the unique physiology and anatomy of pediatric patients that is increasingly receiving more attention. However, there is limited literature on the programs within children's hospitals and academia that can support pediatric device development. We describe our experience with pediatric device design utilizing collaborations between a children's hospital and two engineering schools. METHODS: Utilizing the academic year as a timeline, unmet pediatric device needs were identified by surgical faculty and matched with an engineering mentor and a team of students within the Capstone Engineering Design programs at two universities...
February 6, 2017: Journal of Pediatric Surgery
https://www.readbyqxmd.com/read/28008591/mirror-syndrome-after-fetoscopic-laser-treatment-a-case-report
#13
Ana Maria Simões Brandão, Ana Patrícia Rodrigues Domingues, Etelvina Morais Ferreira Fonseca, Teresa Maria Antunes Miranda, José Paulo Achando Silva Moura
Mirror syndrome is a rare disease with unknown pathophysiology that can be present in different diseases that can cause fetal hydrops. The prognosis is usually bad with a high perinatal mortality. We report an unusual form of mirror syndrome that manifested itself only after a successful treatment for fetal hydrops (caused by twin-twin transfusion syndrome, in Quinteros stage IV) was performed. This syndrome was controlled by medical treatment, and despite the usually bad prognosis seen in these cases, we could extend the pregnancy from the 23rd to the 34th week of gestation, resulting in the birth of 2 live infants...
November 2016: Revista Brasileira de Ginecologia e Obstetrícia
https://www.readbyqxmd.com/read/28005161/-epidural-anesthesia-for-fetoscopy-retrospective-analysis-of-a%C3%A2-one-year-cohort
#14
N Kiefer, S F Suter, C Berg, U Gembruch, S U Weber
BACKGROUND: The introduction of routine prenatal screening using ultrasound has led to a substantial increase in diagnoses of fetal disorders that are amenable to intrauterine treatment. While an ultrasound guided insertion of small bore cannulas can be performed under local anesthesia, insertion of a fetoscope usually requires anesthetic management for the mother and the fetus. Additionally, the fetus' intrauterine position may have to be manipulated in order to enable access. Such manoeuvres depend on relaxation of the mother's abdominal wall...
January 2017: Der Anaesthesist
https://www.readbyqxmd.com/read/27926636/feasibility-and-outcomes-of-fetoscopic-tracheal-occlusion-for-severe-left-diaphragmatic-hernia
#15
Michael A Belfort, Oluyinka O Olutoye, Darrell L Cass, Olutoyin A Olutoye, Christopher I Cassady, Amy R Mehollin-Ray, Alireza A Shamshirsaz, Stephanie M Cruz, Timothy C Lee, David G Mann, Jimmy Espinoza, Stephen E Welty, Caraciolo J Fernandes, Rodrigo Ruano
OBJECTIVE: To evaluate feasibility and initial outcomes of fetoscopic tracheal occlusion for severe diaphragmatic hernia compared with a historical cohort who had not received fetal tracheal occlusion. METHODS: Outcomes in a prospective observational cohort who underwent fetoscopic tracheal occlusion for severe fetal left diaphragmatic hernia without associated anomalies were compared with our historical nontreated cohort of matched fetuses of similar severity. Fetuses were classified using the same ultrasonography and magnetic resonance imaging methodology-prospectively in the fetoscopic tracheal occlusion group and retrospectively in the historical nontreated cohort...
January 2017: Obstetrics and Gynecology
https://www.readbyqxmd.com/read/27830929/fetal-surgery-for-myelomeningocele-current-clinical-practice-and-translational-research
#16
Sandra K Kabagambe, Yue J Chen, Diana L Farmer
INTRODUCTION: The Management of Myelomeningocele Study (MOMS) showed that prenatal repair of myelomeningocele (MMC) resulted in better neurological outcomes than postnatal closure but was, by necessity, associated with higher rates of obstetrical complications. Fetoscopic MMC repair has been explored as an alternative to reduce complications of the open approach used in MOMS. This review summarizes the trends in fetoscopic and open fetal repair of MMC. EVIDENCE ACQUISITION: We searched PubMed and Embase® for studies on fetal repair of MMC published since the completion of the MOMS trial...
February 2017: Minerva Pediatrica
https://www.readbyqxmd.com/read/27813120/prediction-of-neonatal-outcome-of-ttts-by-fetal-heart-and-doppler-ultrasound-parameters-before-and-after-laser-treatment
#17
A Delabaere, F Leduc, Q Reboul, F Fuchs, S Wavrant, J C Fouron, F Audibert
OBJECTIVES: To determine the prognostic value of fetal Doppler and echocardiographic parameters for neonatal survival up to 30 days after laser coagulation in monochorionic pregnancies complicated by twin-twin transfusion syndrome (TTTS). METHODS: Fetal echocardiography and outcome data of consecutive cases of TTTS treated by laser were retrospectively reviewed. Hemodynamic and cardiac function parameters were collected before and after laser. RESULTS: Between February 2006 and January 2015, 106 fetoscopic laser were performed...
December 2016: Prenatal Diagnosis
https://www.readbyqxmd.com/read/27751419/outcome-of-twin-twin-transfusion-syndrome-treated-by-laser-therapy-in-taiwan-s-single-center-role-of-quintero-staging-system
#18
Yao-Lung Chang, An-Shine Chao, Shuenn-Dyh Chang, Peter Cc Hsieh, Sheng-Yuan Su, Kuan-Ju Chen, Po-Jen Cheng, Tzu-Hao Wang
OBJECTIVE: To evaluate the outcome of twin-twin transfusion syndrome (TTTS) treated by fetoscopic laser therapy (FLT) stratified by Quintero staging. MATERIALS AND METHODS: A total of 100 TTTS cases treated by FLT, from October 2005 to August 2014, were included in this study. Cases were divided into first and second half periods to evaluate the learning effect-related outcomes, and logistic regression was applied to determine the independent factors in predicting the perinatal outcomes...
October 2016: Taiwanese Journal of Obstetrics & Gynecology
https://www.readbyqxmd.com/read/27705970/successful-in-utero-percutaneous-fetoscopic-release-of-a-wrapped-pleuro-amniotic-shunt-around-the-fetal-arm-case-report-and-review-of-the-literature
#19
Ahmed A Nassr, Rodrigo Ruano, Jimmy Espinoza, Alireza A Shamshirsaz
BACKGROUND AND OBJECTIVES: 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. DATA SOURCE: 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...
October 6, 2016: Fetal Diagnosis and Therapy
https://www.readbyqxmd.com/read/27686840/amniopatch-treatment-of-iatrogenic-preterm-premature-rupture-of-membranes-ipprom-after-fetoscopic-laser-surgery-for-twin-twin-transfusion-syndrome
#20
Ramen H Chmait, Eftichia V Kontopoulos, Andrew H Chon, Lisa M Korst, Arlyn Llanes, Rubén A Quintero
OBJECTIVES: Amniopatch is a proposed treatment of iatrogenic preterm premature rupture of membranes (iPPROM). We studied characteristics associated with successful amniopatch treatment of iPPROM after fetoscopic laser surgery for twin-twin transfusion syndrome. METHODS: Patients with iPPROM within 15 days of laser surgery treated with an amniopatch were studied. Factors associated with amniopatch success (i.e. cessation of leakage with normalization of amniotic fluid volume) were tested univariately and in multivariate logistic regression models...
August 10, 2016: Journal of Maternal-fetal & Neonatal Medicine
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