Journal
AMERICAN JOURNAL OF OBSTETRICS AND GYNECOLOGY
Volume 200, Issue 4, Pages -Publisher
MOSBY-ELSEVIER
DOI: 10.1016/j.ajog.2009.01.051
Keywords
echocardiography; fetoscopy; laser coagulation; monochorionic twins; twin-to-twin transfusion syndrome
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Funding
- Flemish Government [IWT 070715]
- European Commission [CT2005 019707, LSHC-CT2006-037409, QLG1-CT-2002-01632]
- Fonds voor Wetenschappelijk Onderzoek-Vlaanderen [1.8.012.07.N.02]
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OBJECTIVE: We sought to assess fetal cardiac function in monochorionic twins before and after therapy for twin-to-twin transfusion syndrome (TTTS) and compare it with control subjects. STUDY DESIGN: We conducted prospective longitudinal assessment of fetal cardiac function in cases undergoing curative fetal therapy for TTTS (n = 39) until 4 weeks postoperatively and in uncomplicated monochorionic twins (n = 23). Fetal cardiac function was assessed by the left and right ventricular myocardial performance index, atrioventricular valve flow pattern, ductus venosus a-wave, and umbilical vein pulsations. RESULTS: Nomograms for the myocardial performance index were constructed. Fetal cardiac function was grossly abnormal in recipient twins of TTTS when compared with control subjects (P < .001 for all indices) but normalized by 4 weeks postoperatively. The donor developed abnormal ductus venosus flow and tricuspid regurgitation postoperatively that regressed within 4 weeks. CONCLUSION: The cardiac dysfunction in the recipient twin of TTTS normalizes within 1 month after laser. The donor develops a transient impairment of cardiac function postoperatively.
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