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Obstetrics & Gynecology:
doi: 10.1097/AOG.0000000000000098
Case Report

Fetal Cardiac Tamponade in a Case of Right-Side Congenital Diaphragmatic Hernia

Salmanian, Bahram MD; Shamshirsaz, Alireza A. MD; Cass, Darrell L. MD; Javadian, Pouya MD; Ruano, Rodrigo MD, PhD; Ayres, Nancy A. MD; Mehollin-Ray, Amy MD; Belfort, Michael A. MD, PhD

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BACKGROUND: Intrafetal fluid collection is a rare ultrasound finding in fetuses with right-side congenital diaphragmatic hernia.

CASE: Our patient had a fetus with a large right-side congenital diaphragmatic hernia with a significant amount of the fetal liver herniated into the chest. At 31 weeks of gestation, the fetus had significant ascites and high-pressure intrathoracic fluid accumulation, hydrops fetalis, deviation of the mediastinum, and tamponade-like physiology that compromised cardiac function. Ultrasound-guided fetal thoracoamniotic and peritoneal amniotic shunt placement markedly improved the fetal cardiac function and resolved the hydrops. The patient delivered at 34 weeks of gestation because of preterm labor and the neonate had an uncomplicated diaphragmatic hernia repair 3 days after delivery.

CONCLUSION: Fetal thoracoamniotic shunting in selected cases of congenital diaphragmatic hernia with hydrops may improve the prognosis.

© 2014 by The American College of Obstetricians and Gynecologists.


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