Chapter 1 of 6 · Surgical Management
Vessel occlusion techniques
Fetal thoracic interventions: techniques and complications
Expert statements on this page
No expert statements were drawn from this page.
Host summaries · secondary, not cited in answers
Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
Video
Lung Lesions: Fetal Interventions Parts I+II
30 min · Published Aug 2012
Video
Prenatal Management of CPAMs: Lung Lesions
18 min · Published Aug 2012
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Fetal Interventions Part I: Lung Lesions
14 min · Published Aug 2012
Video
Postnatal Management of Lung Lesions Part I: Pediatric Thoracic Surgery Part...
Dr. Todd Ponsky · 31 min · Published Aug 2017
Video
Open Fetal Surgery Overview: Fetal Surgery 2012
37 min · Published Jul 2015
Podcast
The Full Story on CPAMs
56 min · Published Sep 2021
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Quick Literature Updates Episode 18
4 min · Published Mar 2025
Podcast
Journal of Pediatric Surgery Article Review: October 2023
12 min · Published Apr 2024
Video
Clinical Symptoms Affect Treatment and Prognosis in Pediatric Patients with Congenital Pulmonary Airway Malformation
55 s · Published Dec 2023
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Update Course Rewind: Congenital Lung Lesions 2022
4 min · Published Aug 2023
Video
Update Course 2022 - APSA PDC UPDATES - Mary Edwards, Paul Jeziorczak, Craig Lillehei, and Charles Snyder,
64 min · Published Sep 2022
Podcast
Case Based Journal Review - CPAM in 2022
12 min · Published Apr 2022
Video
Intestinal Atresia Types Explained: Grossfeld Classification for Pediatric Surgery
1 min · Published Sep 2026
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Derivation and validation of the Pediatric Community-Acquired Pneumonia Severity (PedCAPS) score: A prospective cohort study
50 s · Published Sep 2026
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FETO for Late-Diagnosed Severe Congenital Diaphragmatic Hernia (CDH) at Cincinnati Children's with Dr. Beth Rymeski
4 min · Published Sep 2026
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Severe Congenital Diaphragmatic Hernia (CDH) Case: FETO Management & Unexpected Findings with Dr. Beth Rymeski
3 min · Published Sep 2026
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Fetoscopic Endoluminal Tracheal Occlusion (FETO) Procedure: Step-by-Step Guide with Dr. Beth Rymeski
4 min · Published Sep 2026
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Choledochal Cyst Types Explained: Pediatric Surgery Fundamentals
1 min · Published Sep 2026
What the experts said
Radiofrequency ablation for vessel occlusion in fetal bronchopulmonary sequestrations was a disaster and is not recommended.
Coils were used for vessel occlusion with initial success, but the fetus died about a week later for unclear reasons.
Alcohol injection for vessel occlusion can travel through the vasculature and cause thrombosis in the systemic circulation, including thrombi in the heart chambers.
The effects of systemic alcohol injection on fetal neural development and other organ development have not been studied experimentally, even in sheep models.
Radiofrequency ablation cannot be controlled in the fetus due to 90% water content; energy can disperse unpredictably causing collateral damage.
In a laboratory study, a radiofrequency ablation probe placed in one side of a resected fetal teratoma caused the other side to boil when activated.
Probably 95% of CCAMs are now prenatally diagnosed.
Almost none of prenatally diagnosed lung lesions require prenatal intervention, and very few require intervention the day the child is born.
Only one or two centers in the world should be thinking about extreme fetal interventions for lung lesions because the numbers are so small.
Many lung lesions have been referred after a recommendation for termination by people who don't understand the natural history.
Even very large prenatal lung lesions can regress and be asymptomatic at birth, or have very good survival rates with appropriate interventions.
The garden variety postnatal CCAM is very different than some prenatal CCAMs.
Some lesions that look like CCAMs in utero, such as segmental bronchial stenosis, can be minimally apparent or non-apparent after birth.
True cystic CCAMs do not disappear; they regress but remain present and prominent on CT scan a month after birth.
Prenatal lung lesions should be called 'congenital lung lesions' (macrocystic, hyperechoic, or mixed) rather than CCAMs, since CCAM is a pathological diagnosis requiring a specimen.
Many tertiary centers have the capacity to perform EXIT procedures with a huge team approach and leadership.
Lung agenesis can be misdiagnosed as a microcystic CCAM with mediastinal shift on prenatal imaging.
EXIT procedures are more invasive than regular C-sections for the mother.
Pleuro-amniotic shunts are used specifically for macrocystic CCAMs with evidence of hydrops.
Hydrops requires pleural effusion, pericardial effusion, and skin or scalp edema; pure ascites alone is not necessarily hydrops.
Pure ascites can be related to mediastinal shift and hepatic venous return rather than true hydrops.
Pleuro-amniotic shunts are not placed prophylactically; large macrocystic lesions may be tapped just prior to delivery to improve ventilation.
A CVR cutoff of 1.6 is used; if a CCAM presents with CVR less than 1.6, the likelihood of evolving hydrops is about 3-5%.
CVR greater than 1.6 requires close watching with much higher likelihood of evolving into hydrops.
Macrocystic lesions are a wild card because the cystic component can grow very rapidly and can be worrisome even if CVR is less than 1.6.
MRI is better for some fetal anomalies and not as good for others; it depends on the specific anomaly.
There is no registry for fetal surgery or EXIT procedures similar to the ECMO registry.