Impact of selective laser ablation of placental anastomoses on the cardiovascular pathology of the recipient twin in severe twin-twin transfusion syndrome.

Abstract

OBJECTIVES:

We investigated the impact of selective laser ablation on the cardiovascular pathology of the recipient twin in twin-twin transfusion syndrome.

STUDY DESIGN:

Fetal echocardiograms and medical records were reviewed from 22 pregnancies with severe twin-twin transfusion syndrome where echocardiography was performed before and after laser.

RESULTS:

Before laser, cardiomegaly associated with right and/or left ventricular hypertrophy without ventricular dilatation, was observed in most cases. Right ventricular and left ventricular systolic dysfunction (shortening fraction <28%) was present in 59% and 27%, respectively, and diastolic dysfunction (based on inflow and venous Dopplers) in 73%. Shortly after laser, biventricular systolic function improved significantly and diastolic function tended to improve (50%, P = .06). Functional pulmonary atresia, secondary to right ventricular systolic dysfunction, resolved in 2 of 2 cases at post-laser echocardiography. On serial assessment, diastolic function was normal in 7 of 10, hydrops regressed in 4 of 5, and neither progressive myocardial hypertrophy nor anatomical right ventricular outflow obstruction were found.

CONCLUSIONS:

Selective laser ablation in severe twin-twin transfusion syndrome acutely improves biventricular systolic function and tends to improve diastolic function in the recipient twin.

• Authors: Catherine Barrea, Lisa K Hornberger, Fawaz Alkazaleh, Brian W McCrindle, Anita Roberts, Olena Berezovska, Rory Windrim, P Gareth Seaward, Jeffrey F Smallhorn, Greg Ryan
• Journal: American journal of obstetrics and gynecology (Am J Obstet Gynecol) Vol. 195 Issue 5 Pg. 1388-95 (Nov 2006) ISSN: 1097-6868 [Electronic] United States
• PMID: 16777050 (Publication Type: Journal Article, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Arteriovenous Anastomosis (surgery)
• Cardiomegaly (diagnostic imaging, embryology)
• Echocardiography
• Female
• Fetofetal Transfusion (diagnostic imaging, physiopathology, surgery)
• Heart Diseases (embryology, physiopathology)
• Humans
• Hydrops Fetalis (physiopathology)
• Laser Therapy
• Placenta (blood supply)
• Pregnancy
• Severity of Illness Index
• Twins
• Ventricular Function