American Journal of Obstetrics & Gynecology
Volume 200, Issue 4 , Pages 400.e1-400.e7, April 2009

Assessment of fetal cardiac function before and after therapy for twin-to-twin transfusion syndrome

This research was presented at the 29th Annual Meeting of the Society for Maternal–Fetal Medicine, San Diego, CA, Jan. 26-31, 2009.

Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium

Received 20 November 2008; received in revised form 29 December 2008; accepted 29 January 2009.

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.

Keywords: echocardiography, fetoscopy, laser coagulation, monochorionic twins, twin-to-twin transfusion syndrome

To access this article, please choose from the options below

Login to an existing account or Register a new account.

  • Purchase this article for 30.00 USD (You must login/register to purchase this article)

    Online access for 24 hours. The PDF version can be downloaded as your permanent record.

  • Subscribe to this title

    Get unlimited online access to this article and all other articles in this title 24/7 for one year.

  • Claim access now

    For current subscribers with Society Membership or Account Number.

  • Visit SciVerse ScienceDirect to see if you have access via your institution.
 

 T.V.M. is supported by the Flemish Government through a fellowship of the Instituut voor Wetenschap en Technologie (IWT 070715). The European Commission funds the fellowships of E.D. and P.K. (Marie Curie Programme MEST CT2005 019707), L.G. (EuroSTEC; LSHC-CT-2006-037409), and L.L. (EuroTwin2Twin #QLG1-CT-2002-01632). J.D. is the recipient of a Fundamental Clinical Researcher Grant of the Fonds voor Wetenschappelijk Onderzoek-Vlaanderen (1.8.012.07.N.02).

 Reprints not available from the authors.

 Cite this article as: Van Mieghem T, Klaritsch P, Doné E, et al. Assessment of fetal cardiac function before and after therapy for twin-to-twin transfusion syndrome. Am J Obstet Gynecol 2009;200:400.e1-400.e7.

PII: S0002-9378(09)00118-5

doi:10.1016/j.ajog.2009.01.051

American Journal of Obstetrics & Gynecology
Volume 200, Issue 4 , Pages 400.e1-400.e7, April 2009

Article Tools

* Image Usage & Resolution