Suh DI, et al. Allergy Asthma Immunol Res. 2019 May;11(3):357-366. https://doi.org/10.4168/aair.2019.11.3.357

To report our experience with management of fetuses with congenital high airway obstruction syndrome (CHAOS). We retrospectively reviewed the cases of fetuses who were prenatally diagnosed and postnatally confirmed with CHAOS between 2010 and 2019 at Asan Medical Center, Seoul, Korea. Of 13 fetuses prenatally diagnosed with CHAOS, 7 were lost to follow-up and 6 were postnatally confirmed as having CHAOS. All fetuses, except one were delivered via cesarean section with an ex utero intrapartum treatment (EXIT) procedure. Two patients had coexisting congenital heart diseases requiring several cardiac surgeries following birth. Both of these patients demonstrated developmental delay; however, the remaining 4 had a normal development except for expressive language. Two infants died of respiratory complications, and the remaining 4 were alive at the end of the follow-up period. All 4 live patients underwent tracheostomy with planned reconstruction surgery. Three children are now able to phonate, and 1 can maintain a conservation. The proper management of CHAOS using the EXIT procedure results in high survival and low hypoxemia-induced complication rates. Therefore, an accurate prenatal diagnosis is necessary for an appropriate perinatal management.

Background: To assess fetal cardiac parameters predictive of postnatal operation type in fetuses with tetralogy of Fallot (TOF).Methods: Echocardiographic data obtained in the second and third trimesters were retrospectively reviewed for fetuses diagnosed with TOF between 2014 and 2018 at Asan Medical Center. The following fetal cardiac parameters were analyzed: 1) pulmonary valve annulus (PVA) z-score, 2) right pulmonary artery (RPA) z-score, 3) aortic valve annulus (AVA) z-score, 4) pulmonary valve peak systolic velocity (PV-PSV), 5) PVA/AVA ratio, and 6) RPA/descending aorta (DAo) ratio. These cardiac parameters were compared between a primary corrective surgery group and a palliative shunt operation followed by complete repair group.Results: A total of 100 fetuses with TOF were included. Only one neonatal death occurred. Ninety patients underwent primary corrective surgery and 10 neonates underwent a multistage surgery. The PVA z-score, RPA z-score, and RPA/DAo ratio measured in the second trimester and the PVA z-score, RPA z-score, and PVA/AVA raio measured in the third trimester were significantly lower in the multistage surgery group, while the PV-PSV as measured in both trimesters were significantly higher in the multistage surgery group.Conclusion: Fetal cardiac parameters are useful for predicting the operation type necessary for neonates with TOF.

To evaluate the clinical features of fetuses with prenatally diagnosed parvovirus B19 infection and fetal hydrops. Parvovirus infection was diagnosed by PCR analysis of amniotic fluid or fetal blood. Fetal anemia was assessed by Doppler measurements of the middle cerebral artery peak systolic velocity (MCA-PSV) and confirmed by fetal blood. Intrauterine transfusions (IUT) were performed only if the MCA-PSV was > 1.5°MoM. In our study population 10 cases of parvovirus infection which were associated with fetal hydrops were reviewed. The median gestational age at diagnosis was 21 (16.3-24.2) weeks. Five of our cases received IUT and four fetuses survived. The remaining five cases were managed conservatively and two fetuses survived. The survival rate for parvovirus infection associated with fetal hydrops was 60%. MCA-PSV and IUT are useful for the management and treatment of fetal anemia due to parvovirus infection.