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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

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

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.

In Brief

Fetal thoracoamniotic shunting in a case of severe right-side congenital diaphragmatic hernia with hydrops may improve the prognosis.

Author Information

Divisions of Maternal Fetal Medicine and Fetal Intervention, Department of Obstetrics and Gynecology, and the Division of Pediatric Cardiology, Department of Pediatrics, Baylor College of Medicine and Texas Children's Hospital, the Division of Pediatric Surgery, Texas Children's Fetal Center and Michael E. DeBakey Department of Surgery, and the Department of Radiology, Baylor College of Medicine, Houston, Texas.

Corresponding author: Alireza A. Shamshirsaz, MD, Texas Children's Fetal Center and the Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, TX 77030; e-mail: alirezashamshirsaz@yahoo.com, shamshir@bcm.edu.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2014 by The American College of Obstetricians and Gynecologists.