PMC10333579_01
The fetal thoracoamniotic shunt is a double pigtail catheter (scale: centimeters).
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F1
TAS, which is a double-pigtail catheter, was placed without complications at 30 weeks of gestation (Figure 1). The ultrasound scan 24 h after the procedure showed resolution of both the pleural effusion and mediastinal shift.
Prenatal ultrasound screening and postnatal chest radiography. (A) The ultrasound examination identified reaccumulated pleural effusion and clearly visualized the entire double-pigtail shunt (red arrows) located within the fetal chest, while the intra-amniotic segment remained invisible. (B) The chest x-ray displayed a massive left pleural effusion with dislodgement of the thoracoamniotic shunt. (C) The chest x-ray showed that the dislodged shunt had migrated to the left upper thorax.
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F2
However, at 31+2 weeks, pleural effusion reaccumulated once again and this time, the whole TAS was clearly detected within the fetal chest but the intra-amniotic segment was invisible, indicating intrathoracic migration (Figure 2A). The infant's respiratory condition was unstable, and chest x-ray revealed massive left pleural effusion with dislodgement of the thoracoamniotic shunt (Figure 2B). After evaluating the patient's condition and the position of the shunt, which had migrated to the left upper thorax (Figure 2C), minimally invasive removal of the retained double-pigtail catheter was scheduled on day 17 postnatally.
Operative images. (A) The cystoscope, which has a 4.2 Fr straight channel (red arrow) and two irrigation channels (yellow arrowhead), was inserted into the pleural cavity via a 3-mm incision without trocar insertion. (B) An endoscopic grasping forceps was inserted through the 4.2 Fr channel and grasped the shunt.
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F3
A 3-mm incision was made overlying the fifth intercostal space in the mid-axillary line, and the cystoscope was inserted directly into the pleural cavity without trocar insertion (Figure 3A). After careful inspection of the thoracic cavity, we located the shunt catheter behind the left upper lobe and extracted it using an endoscopic grasping forceps inserted through the 4.2 Fr working channel of the cystoscope (Figure 3B).