Radiofrequency ablation for giant congenital lung malformations complicated by fetal hydrops: a retrospective case series

OBJECTIVE: To evaluate the surgical efficacy and prognosis of radiofrequency ablation (RFA) in the treatment of microcystic congenital pulmonary airway malformation (CPAM) complicated by fetal hydrops, with the CLM volume ratio (CVR) exceeding 2.0 and refractory to conservative treatment with maternal steroid administration. METHODS: We collected data from fetal microcystic CPAM cases with CVR > 2.0, complicated by fetal hydrops, and refractory to maternal steroid therapy, who underwent RFA at our hospital from June 2020 to June 2024. RESULTS: The study comprised five fetuses, all diagnosed with microcystic CPAM complicated by fetal hydrops. All fetuses had a mean CVR of 3.8 (range, 2.2-5.3) and were complicated by fetal hydrops. All cases received two courses of maternal steroid before the RFA procedure. Among the five cases, three newborns were delivered at a mean gestational age of 36.6 weeks (range 35.2-38.7 weeks), and two cases of IUFD occurred postoperatively. CONCLUSION: For microcystic CPAM complicated with fetal hydrops and refractory to maternal conservative steroid administration, ultrasound-guided RFA serves as an effective salvage option for intrauterine treatment. Nevertheless, intrauterine interventional procedures should be performed with extreme caution, given the potential risks of IUFD.