OC03.06: Ultrasound‐guided laser ablation of the feeding artery in non‐hydropic fetuses with large bronchopulmonary sequestration

To assess the impact of fetal laser ablation of the feeding artery in survival and need for neonatal surgery in fetuses with large bronchopulmonary sequestration (BPS) presenting without hydrops or hydrothorax. A consecutive cohort of fetuses with large BPS (CVR above 1.0) and mediastinal shift, without hydrops or pleural effusion, was treated with percutaneous ultrasound-guided fetal laser ablation of the feeding artery (FLAFA) beyond 30 weeks of gestation in a single fetal surgery centre in Mexico from January 2012 to February 2024. Fifteen fetuses with large BPS were included with a median presurgical CVR of 1.5 (1.0-3.5), a systemic artery diameter of 4.2 (1.7-7.2) mm, and peak systolic velocity of 55.8 (15-99)cm/s. FLAFA was successfully performed in all cases at a median gestational age (GA) of 31.0 (30.0-33.7) weeks with a median surgical time of 17.5 (4-100) min. Four cases (26.7%) required more than one fetal intervention. Three cases (20%) showed intrathoracic bleeding and one (6.7%) required intrauterine fetal blood transfusion. After fetal intervention, a progressive regression of the lung mass size was observed in all cases. One case (6.7%) showed preterm rupture of the membranes and preterm delivery. All cases were delivered liveborn at a mean GA at birth of 38.9 (35.6-40.9) weeks. All neonates were asymptomatic; none required mechanical ventilation or oxygen support, and consequently no need for neonatal sequestrectomy. Fetal laser ablation of the feeding artery avoids the need for neonatal sequestrectomy in non-hydropic fetuses with large BPS and mediastinal shift.