EP10.02: Thoracoamniotic shunts in isolated large macrocystic congenital cystic adenomatoid malformations

Evaluate the effectiveness of thoracoamniotic shunts for drainage of macrocystic congenital adenomatoid malformation (CCAM), correction of mediastinal shift, resolution of hydrops and neonatal survival. Retrospective study of 8 fetuses with a large thoracic cyst treated with thoracoamniotic shunting between 2013 and 2023 in a tertiary fetal therapy centre. In all cases the thoracic cysts were associated with severe mediastinal shift and in six cases (75%) with hydrops. Shunt insertion was successfully carried out in all cases at a median gestational age of 24 weeks (range 18-34). All the cases presented a significant reduction of CCAM size, correction of mediastinal shift and hydrops resolution after shunt placement. One case required a second shunt insertion after 5 weeks due to intrathoracic shunt displacement. In all the cases there was a live birth at a median age of 35 weeks (range 26-40). However one case, with shunt placed at 18 weeks and delivery at 26, died postnatally due to respiratory complications. Resulting in a postnatal survival rate of 87.5%. Fetal thoracoamniotic shunting for large macrocystic CCAM is associated with favourable outcome in most cases, being premature delivery its main complication in our series.