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>> FOR THE TYPES OF CCAMS THAT HAVE A LARGE SINGLE OR COMPLEX CYST,
YOU CAN TREAT THEM BY PLACING A SHUNT.
AND THAT CAN BE DONE BY USING A NEEDLE SYSTEM,
WHERE THE NEEDLE IS INSERTED UNDER ULTRASOUND GUIDANCE
INTO THE BABY'S CHEST, DIRECTED INTO THE LARGE CYST,
AND THEN A SMALL PLASTIC CATHETER CALLED A "ROCKET DOUBLE PIGTAIL"
SHUNT CAN BE PLACED INTO THAT CYST, AND THEN THROUGH THE CHEST WALL
INTO THE AMNIOTIC CAVITY.
>> ONE END OF THE PIGTAIL GOES INTO THE CYST.
THE MAIN PART OF THE CATHETER GOES THROUGH THE BABY'S CHEST WALL,
AND THE OTHER PIGTAIL CURLS UP IN THE AMNIOTIC FLUID SPACE,
SUCH THAT THE FLUID WITHIN ONE OR TWO OF THESE VERY LARGE
CYSTS IS DECOMPRESSED INTO THE FLUID SO THE HUGE MASS THEN SHRINKS.
>> THE PROBLEM WITH THE LUNG MASSES IS THAT THEY'RE A SPACE-OCCUPYING
LESION AND THE LARGER THAT VOLUME OF THE LESION WITHIN THE CHEST,
THE MORE PROBLEMS IT CAN CAUSE.
>> WE ONLY COUNSEL PATIENTS ABOUT FETAL INTERVENTION
IF THE TUMORS ARE AT HIGH RISK FOR CAUSING HYDROPS.
>> THE MEDICAL TERM FOR HEART FAILURE IN A FETUS IS FETAL HYDROPS.
AND WHAT WE USUALLY SEE IN INITIALLY IN THOSE CASES
IS THE ACCUMULATION OF FLUID IN THE BODY CAVITIES OF THE FETUS.
ONE OF THE TREATMENT OPTIONS FOR THE MOM CARRYING A FETUS
WITH A LARGE LUNG LESION, WITH ASSOCIATED FETAL HEART FAILURE,
OR FETAL HYDROPS, IS TO REMOVE THE LESION BEFORE BIRTH.
>> YOU HAVE TO OPEN THE MOTHER.
YOU HAVE TO OPEN THE UTERUS.
YOU HAVE TO POSITION THE BABY, OPEN THE BABY'S CHEST,
AND TAKE THE TUMOR OUT.
>> THAT INVOLVES MAKING A CUT, A SIDEWAYS CUT IN THE CHEST,
SPREADING THE RIBS, DELIVERING THE MASS,
WHICH USUALLY ARISES FROM ONE LOBE.
WE REMOVE THAT LOBE, SPARE THE NORMAL LUNG TISSUE,
WHICH IS SMALL AND HAS BEEN SQUISHED, AND THEN CLOSE THE CHEST,
CLOSE THE UTERUS, CLOSE THE MOM,
WITH AN ABSORBABLE STITCH THAT WILL DISSOLVE ONCE SHE'S HEALED.
IT'S AN OPERATION NOT ONLY FOR THE FETUS WHO HAS EVERYTHING
TO GAIN, BUT ALSO FOR THE MOTHER, WHO'S SORT OF, MEDICALLY,
AN INNOCENT BYSTANDER.
THE FINAL SCENARIO, AS FAR AS TREATMENT GOES,
ARE THOSE FETUSES WITH VERY LARGE LESIONS,
LATENT GESTATION, MAY HAVE ALREADY RECEIVED A SHUNT
BUT THE LESION STILL REMAINS VERY LARGE, AND WE'RE WORRIED
THAT WE WON'T BE ABLE TO VENTILATE THE BABY AFTER BIRTH
BECAUSE THE MASS IS SO BIG.
>> FOR MY SON THE SURGERY THAT WOULD GIVE HIM THE BEST
CHANCE OF SURVIVAL WAS WHAT'S CALLED AN "EXIT PROCEDURE."
>> AN EXIT PROCEDURE IS A LOT MORE THAN A C-SECTION.
WE DON'T WANT TO CONFUSE THE TWO AT ALL.
IT IS AN ABDOMINAL INCISION ON THE MOM.
MAMA'S ASLEEP, BUT UNLIKE A C-SECTION WHERE WE'RE TRYING
TO GET THE BABY OUT QUICKLY AND HAVE THE UTERUS CONTRACT BACK
DOWN VERY QUICKLY, WE WANT THE UTERUS TO STAY RELAXED.
AND WE WANT TO PLACENTAL CIRCULATION TO STAY INTACT.
WE WANT THERE TO BE GAS EXCHANGE BETWEEN THE MOM AND THE BABY
IN ORDER TO PROTECT THE BABY.
>> BY DOING IT THAT WAY, THE BABY IS ESSENTIALLY ON BYPASS.
MOM CONTINUES TO DO ALL THE WORK, PROVIDE THE BABY WITH OXYGEN.
>> ONCE THE MASS IS REMOVED AND THE BABY IS ADEQUATELY
RESUSCITATED, WE CAN START VENTILATING, WHICH CHANGES ALL
THE DYNAMICS OF HOW THE PLACENTAL BLOOD FLOW WORKS.
AND THEN WE CAN OFFICIALLY DELIVER THE BABY.
>> YOU THINK TO YOURSELF, "WOW, HE SURVIVED THAT.
I SURVIVED THAT, AND LOOK AT HIM.
HE'S RUNNING AROUND.
HE'S PLAYING ON THE BEACH.
HE'S PLAYING WITH HIS SIBLINGS, AND HE'S NO DIFFERENT THAN THEY ARE."