Fetal laser ablation of feeding artery of cystic lung lesions with systemic arterial blood supply.

OBJECTIVE: To assess the effectiveness of laser surgery in fetuses with a cystic lung lesion with systemic arterial blood supply (hybrid lung lesion) at risk of perinatal death. METHODS: A cohort of five consecutive fetuses with a large hybrid lung lesion associated with hydrops and/or pleural effusion with severe lung compression was selected for percutaneous ultrasound-guided fetal laser ablation of the feeding artery (FLAFA) before 32 weeks' gestation in a single tertiary national referral center in Queretaro, Mexico. The primary outcomes were survival and need for postnatal surgery. RESULTS: FLAFA was performed successfully in all cases at a median gestational age of 24.9 (range, 24.4-31.7) weeks. After fetal intervention, dimensions in both lungs increased and fluid effusions resolved in all cases. All cases were delivered liveborn at term at a median gestational age of 39.6 (range, 38.0-39.7) weeks, without respiratory morbidity or need for oxygen support, resulting in perinatal survival of 100%. During follow-up, three (60%) cases showed progressive regression of the entire lung mass and did not require postnatal surgery, whereas in two (40%) cases a progressive decrease in size of the mass was observed but a cystic portion of the lung mass persisted and postnatal lobectomy was required. CONCLUSION: In fetuses with large hybrid lung lesions at risk of perinatal death, FLAFA is feasible and could improve survival and decrease the need for postnatal surgery. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.

[Modified Tei index, interobserver agreement related to sonographer experience level]. / Indice de Tei modificado, variabilidad interobservador según nivel de experiencia ultrasonográfica.

BACKGROUND: increasing numbers of studies that attempt to introduce the Tei index as part of fetal assessment in different conditions (corrected diaphragmatic hernia, supraventricular tachycardia, fetal inflammatory response, cystic adenomatoid disease, fetal-fetal transfusion, etc.). OBJECTIVE: To determine the interobserver agreement in measuring the modified Tei index in observers with different levels of experience in obstetric ultrasound. MATERIAL AND METHOD: Three observers were classified according to their level of experience (A, B and C) and selected 65 images to analyze the modified Tei index interobserver agreement. If all observers felt unanimously that were eligible for analysis, the image was selected. Each observer made the measurements independently. Once complete measurements, archived images and data were analyzed. RESULTS: The lowest variability of the modified Tei index was among the observers A/C (standard deviation of the differences of 27% versus 30% (B/C), versus. 40% (A/B). The correlation coefficient interclass of the three observers together was a regular on the scale of Landis and Koch, and substantial for observer A. The lowest variability of individual parameters was for ejection time. Interobserver variability was less gradually from first to fourth month observations. CONCLUSION: It has not been able to replicate the level of interobserver variability suggested in literature, by the effects of the learning curve in the procurement and selection of images. The modified Tei index interobserver variability was not found influenced by the level of operator experience in this context, but is considered not conclusive until obtain better evidence.