Fetal Intervention for Giant Chorangioma with Prenatal Ductus Arteriosus Closure: A Case Report.

Abstract

Introduction: We present a case of spontaneous premature ductus arteriosus (DA) closure following modified interstitial laser ablation (ILA) of a giant chorangioma (GC) in a fetus with evidence of hydrops.

Case presentation: A 26-week ultrasound revealed a 10-cm GC in the posteriorly located placenta with signs of fetal hydrops, polyhydramnios, and elevated middle cerebral artery peak systolic velocity (MCA PSV) of 1.9 MoM. Preoperative fetal echocardiogram showed elevated combined cardiac output (753 mL/kg/min) without structural abnormalities. Modified ILA targeting the branches of the feeder artery with an extended-pulse technique (30 s at 40 Watts) followed by intrauterine fetal transfusion was performed without complications. On postoperative day (POD) 1, new onset of ductus venosus flow reversal was noted, which was attributed to post-procedural hemodynamics. Fetal echocardiography on POD 5 suggested constriction of DA; follow-up confirmed complete DA closure and secondary right heart dysfunction. The pregnancy was managed expectantly with at least weekly echocardiograms. Digoxin and hyperoxygenation for fetal heart failure did not change DA caliber. Acetaminophen and fluoxetine were discontinued without improvement. After an uncomplicated term cesarean delivery (indication: breech), the female neonate was discharged home on day of life 3. Currently, the child is 6 months old and healthy.

Conclusion: Modified ILA for GC followed by expectant management of associated DA closure yielded a term delivery with a favorable outcome.