New developments in fetal lung surgery.

After more than two decades of experimental and clinical work, fetal surgery has become a reasonable treatment modality for selected fetuses with life-threatening anomalies. We review the literature on anatomic anomalies of the fetal lung that are amenable to fetal surgical therapy. Ultrafast fetal magnetic resonance imaging has enhanced the accuracy of prenatal evaluation. Fetal lung masses associated with hydrops are nearly 100% fatal. These lesions can be resected in utero if they are predominantly solid or multicystic. Thoracoamniotic shunting may be effective in the setting of a single large predominant cyst. Fetuses diagnosed with left congenital diaphragmatic hernia before 26 weeks' gestation, who have liver herniation and a sonographic right lung-to-head circumference ratio of less than 1.0, may benefit from temporary fetal tracheal occlusion to enhance lung growth before birth.