Fetus Establish Tracheal Access for Lifeguard as a Complementary Maneuver for Tracheal Deviation Secondary to Complications of Pulmonary Sequestration: Case Report and Technical Description.

Abstract

Introduction: Bronchopulmonary sequestration (BPS) is a congenital pulmonary malformation that, in severe cases, can lead to fetal hemodynamic compromise, hydrothorax, mediastinal shift, and an increased risk of neonatal airway obstruction. Objective ultrasound-based parameters such as the congenital pulmonary airway malformation volume ratio (CVR), mediastinal shift, and the tracheoesophageal displacement index (TEDI) have been proposed as key predictors of perinatal complications. The ex utero intrapartum treatment (EXIT) procedure enables secure airway management in neonates at risk of severe obstruction.

Case presentation: We report the case of a 27-year-old pregnant patient at 29 weeks of gestation diagnosed with left extra-lobar BPS, with a CVR of 1.7, associated hydrothorax, and mediastinal shift. The fetus underwent laser ablation of the feeding vessel and thoracoamniotic shunting, with improvement in ultrasound parameters. At 36 weeks, persistent residual hydrothorax and a TEDI of 16 were documented, prompting a planned EXIT procedure. An endoscopic-guided intubation technique, termed Fetus Establish Tracheal Access for Lifeguard (FETAL), was developed and successfully employed for airway access. The neonate underwent definitive postnatal surgical resection with favorable postoperative recovery.

Conclusion: A structured strategy allowed timely intervention at each stage of fetal management, optimizing the perinatal outcome. The FETAL technique represents a safe and effective alternative for fetal airway management during EXIT in selected cases at high risk of tracheal obstruction.