Article Data

  • Views 1595
  • Dowloads 170


Open Access

The application of ex utero intrapartum treatment (EXIT) procedure for cardiothoracic disorders


1Department of Cardiothoracic Surgery, The First Hospital of Putian, Teaching Hospital, Fujian Medical University, Putian, Fujian Province, People’s Republic of China

DOI: 10.22514/SV141.052018.1 Vol.14,Issue 1,March 2018 pp.14-16

Published: 27 March 2018

*Corresponding Author(s): SHI-MIN YUAN E-mail:


The ex utero intrapartum treatment (EXIT) procedure was primarily devel-oped to reverse temporary tracheal occlu-sion in patients with fetal surgery for con-genital diaphragmatic hernia. Nowadays, it is widely used to resect fetal neck masses and to maintain an unobstructed airway. It is indicated for the management of several cardiothoracic diseases, including medi-astinal or lung mass resection, drainage of pleural effusions, palliative treatment of critical congenital heart disease and establishment of EXIT-to-extracorporeal membrane oxygenation (ECMO). EXIT has been attempted successfully in many centers, and it has been proven that moth-ers and babies tolerate the procedure well. Maternal and fetal surveillance during an-esthesia is important to maintain maternal blood pressure and placental blood flow and fetal oxygenation. The aim of this arti-cle is to discuss the application of the EXIT procedure for the management of fetal car-diothoracic diseases.


anesthesia, fetus, mediastinal neoplasms, pleural effusion

Cite and Share

SHI-MIN YUAN. The application of ex utero intrapartum treatment (EXIT) procedure for cardiothoracic disorders. Signa Vitae. 2018. 14(1);14-16.


1. Hirose S, Harrison MR. The ex utero intrapartum treatment (EXIT) procedure. Semin Neonatol 2003;8(3):207-14.

2. Bouchard S, Johnson MP, Flake AW, Howell LJ, Myers LB, Adzick NS, Crombleholme TM. The EXIT procedure: experience and outcome in 31 cases. J Pediatr Surg 2002;37(3):418-26.

3. Liechty KW, Crombleholme TM, Flake AW, Morgan MA, Kurth CD, Hubbard AM, Adzick NS. Intrapartum airway management for giant fetal neck masses: the EXIT (ex utero intrapartum treatment) procedure. Am J Obstet Gynecol 1997;177(4):870-4.

4. Liechty KW. Ex-utero intrapartum therapy. Semin Fetal Neonatal Med 2010 Feb;15(1):34-9. doi: 10.1016/j.siny.2009.05.007.

5. Merchant AM, Hedrick HL, Johnson MP, Wilson RD, Crombleholme TM, Howell LJ, et al. Management of fetal mediastinal tera-toma. J Pediatr Surg 2005;40(1):228-31.

6. Agarwal A, Rosenkranz E, Yasin S, Swaminathan S. EXIT procedure for fetal mediastinal teratoma with large pericardial effusion: a case report with review of literature. J Matern Fetal Neonatal Med 2017 Apr 2:1-5. doi: 10.1080/14767058.2017.1306851. [Epub ahead of print]

7. Rychik J, Khalek N, Gaynor JW, Johnson MP, Adzick NS, Flake AW, Hedrick HL. Fetal intrapericardial teratoma: natural history and management including successful in uterosurgery. Am J Obstet Gynecol 2016;215(6):780.e1-780.e7.

8. Cass DL, Olutoye OO, Cassady CI, Zamora IJ, Ivey RT, Ayres NA, et al. EXIT-to-resection for fetuses with large lung masses and persistent mediastinal compression near birth. J Pediatr Surg 2013;48(1):138-44.

9. Benson CB. Fetal cardiac surgery and ex utero intrapartum treatment (EXIT) procedure. Ultrasound Med Biol 2003;29(5):S34.

10. Marwan A, Crombleholme TM. The EXIT procedure: principles, pitfalls, and progress. Semin Pediatr Surg 2006;15(2):107-15.

11. Matte GS, Connor KR, Toutenel NA, Gottlieb D, Fynn-Thompson F. A Modified EXIT-to-ECMO with Optional Reservoir Circuit for Use during an EXIT Procedure Requiring Thoracic Surgery. J Extra Corpor Technol 2016;48(1):35-8.

12. Mohan MS, Patole SK. Isolated fetal pericardial effusion: case report and review of the literature. Aust N Z J Obstet Gynaecol 2002;42(2):216-8.

13. Shenker L, Reed KL, Anderson CF, Kern W. Fetal pericardial effusion. Am J Obstet Gynecol 1989;160(6):1505-7;7-8.

14. Kern C, Ange M, Morales, Peiry B, Pfister RE. Ex utero intrapartum treatment (EXIT), a resuscitation option for intra-thoracic foetal pathologies. Swiss Med Wkly 2007;137(19-20):279-85.

15. Henry PY, Aravindan CS, Sivakumar K, Krishna HR. Extrauterine Intrapartum Treatment (EXIT) in bilateral primary fetal hydro-thorax. Indian J Pediatr 2009;76(1):99-101.

16. Prontera W, Jaeggi ET, Pfizenmaier M, Tassaux D, Pfister RE. Ex utero intrapartum treatment (EXIT) of severe fetal hydrothorax. Arch Dis Child Fetal Neonatal Ed 2002;86(1):F58-60.

17. Moldenhauer J, Endo M, Bebbington M, Adzick NS, Flake AW, Hedrick HL, et al. Maternal morbidity associated with the ex-utero intrapartum treatment (EXIT) procedure. Am J Obst Gynecol 2009;201(6):S164-5.

Abstracted / indexed in

Science Citation Index Expanded (SciSearch) Created as SCI in 1964, Science Citation Index Expanded now indexes over 9,200 of the world’s most impactful journals across 178 scientific disciplines. More than 53 million records and 1.18 billion cited references date back from 1900 to present.

Journal Citation Reports/Science Edition Journal Citation Reports/Science Edition aims to evaluate a journal’s value from multiple perspectives including the journal impact factor, descriptive data about a journal’s open access content as well as contributing authors, and provide readers a transparent and publisher-neutral data & statistics information about the journal.

Chemical Abstracts Service Source Index The CAS Source Index (CASSI) Search Tool is an online resource that can quickly identify or confirm journal titles and abbreviations for publications indexed by CAS since 1907, including serial and non-serial scientific and technical publications.

Index Copernicus The Index Copernicus International (ICI) Journals database’s is an international indexation database of scientific journals. It covered international scientific journals which divided into general information, contents of individual issues, detailed bibliography (references) sections for every publication, as well as full texts of publications in the form of attached files (optional). For now, there are more than 58,000 scientific journals registered at ICI.

Geneva Foundation for Medical Education and Research The Geneva Foundation for Medical Education and Research (GFMER) is a non-profit organization established in 2002 and it works in close collaboration with the World Health Organization (WHO). The overall objectives of the Foundation are to promote and develop health education and research programs.

Scopus: CiteScore 1.0 (2022) Scopus is Elsevier's abstract and citation database launched in 2004. Scopus covers nearly 36,377 titles (22,794 active titles and 13,583 Inactive titles) from approximately 11,678 publishers, of which 34,346 are peer-reviewed journals in top-level subject fields: life sciences, social sciences, physical sciences and health sciences.

Embase Embase (often styled EMBASE for Excerpta Medica dataBASE), produced by Elsevier, is a biomedical and pharmacological database of published literature designed to support information managers and pharmacovigilance in complying with the regulatory requirements of a licensed drug.

Submission Turnaround Time