American Journal of Obstetrics & Gynecology
Volume 202, Issue 1 , Pages 48.e1-48.e7, January 2010

Amniotic fluid markers of fetal cardiac dysfunction in twin-to-twin transfusion syndrome

Presented, in part, in poster format at the 29th Annual Meeting of the Society for Maternal-Fetal Medicine, San Diego, CA, Jan. 26-31, 2009.

  • Tim Van Mieghem, MD

      Affiliations

    • Division of Woman and Child, Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
    • ,
  • Elisa Doné, MD

      Affiliations

    • Division of Woman and Child, Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
    • ,
  • Léonardo Gucciardo, MD

      Affiliations

    • Division of Woman and Child, Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
    • ,
  • Philipp Klaritsch, MD

      Affiliations

    • Division of Woman and Child, Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
    • ,
  • Karel Allegaert, MD, PhD

      Affiliations

    • Department of Pediatrics and Neonatology, University Hospitals Leuven, Leuven, Belgium
    • ,
  • Rita Van Bree

      Affiliations

    • Division of Woman and Child, Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
    • ,
  • Liesbeth Lewi, MD, PhD

      Affiliations

    • Division of Woman and Child, Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium
    • ,
  • Jan Deprest, MD, PhD

      Affiliations

    • Division of Woman and Child, Department of Obstetrics and Gynecology, University Hospitals Leuven, Leuven, Belgium

Received 20 April 2009; received in revised form 7 June 2009; accepted 12 August 2009. published online 05 October 2009.

Objective

The objective of the study was to determine whether cardiac troponin T (cTnT) and natriuretic peptides can be isolated from the amniotic fluid (AF) of pregnancies complicated by twin-to-twin transfusion syndrome (TTTS) and whether they correlate with fetal echocardiographic findings and recipient survival.

Study Design

AF samples from the recipient sac were obtained in 52 TTTS cases and 16 controls. Samples were assayed for cTnT and natriuretic peptides. Prior to fetoscopic laser therapy, 34 recipient twins underwent assessment of atrioventricular flow patterns, myocardial performance index (MPI), and precordial venous Dopplers. Fetal survival was assessed 48 hours postoperatively.

Results

AF B-type natriuretic peptide and cTnT levels were elevated in TTTS and correlated with functional echocardiographic findings. Postoperative recipient survival was 72% when both AF-cTnT and left ventricular MPI were increased. If 1 of both markers was normal, survival was 100% (P = .046).

Conclusion

Combining ultrasound and AF-cTnT measurements allows the identification of fetuses at risk of postoperative demise.

Key words: echocardiography, fetal surgery, natriuretic peptide, troponin, twin-to-twin transfusion

 

 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 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. and K.A. are supported by the Fund for Scientific Research, Flanders (Belgium) (F.W.O. Vlaanderen), with Fundamental Clinical Investigatorships (1.8.012.07.N.02 and 1.8.002.09.N, respectively).

 Cite this article as: Van Mieghem T, Doné E, Gucciardo L, et al. Amniotic fluid markers of fetal cardiac dysfunction in twin-to-twin transfusion syndrome. Am J Obstet Gynecol 2010;202:48.e1-7.

 Reprints not available from the authors.

PII: S0002-9378(09)00919-3

doi:10.1016/j.ajog.2009.08.013

American Journal of Obstetrics & Gynecology
Volume 202, Issue 1 , Pages 48.e1-48.e7, January 2010