General Obstetrics and Gynecology: ObstetricsPrenatal cardiovascular manifestations in the twin-to-twin transfusion syndrome recipients and the impact of therapeutic amnioreduction
Section snippets
Methods
From 1993 to 2001, 78 patients with TTTS were seen in our institutions, 61 of whom were referred for fetal echocardiography as part of their routine assessment; 54 of these patients were included in the analysis (Table I). The diagnosis of TTTS was based on a monochorionic-diamniotic twin pregnancy (single placenta, thin dividing membrane, same gender) that was complicated by a “polyhydramnios (>8 cm depth of amniotic fluid)-oligohydramnios (<2 cm depth of amniotic fluid)” sequence, with the
Results
Fifty-four patients with TTTS were included: 50 pairs of twins and 4 sets of triplets. GA at diagnosis of TTTS was 21 ± 3 weeks. More than one half of the patients were in Quintero stage III. Figure 1 summarizes the case, including the interventions where performed. Amnioreduction was the treatment of choice until 1999; laser was the treatment of choice thereafter, especially for advanced (stage III or IV) or when the diagnosis was made at <22 weeks of gestation.22
Comment
In TTTS, cardiovascular disease occurs in most recipient twins19, 20, 21, 32 and is a major cause of death.33, 34 The recipient's cardiovascular disease also contributes significantly to the donor's morbidity and death. Knowledge of the influence of TTTS on ventricular systolic and diastolic function in the recipient contributes to our understanding of pathophysiologic conditions and may ultimately assist in the identification of the most effective invasive or noninvasive therapies.
Most
Acknowledgments
We thank our obstetric and pediatric colleagues who referred patients and provided prenatal and postnatal follow-up both locally and in other Canadian provinces.
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Supported in part by The Physician's Services Incorporated Foundation, grant no. 78390 and by the Foundation “Saint Luc,” Cliniques Universitaires Saint Luc, Catholic University of Louvain, Brussels, Belgium.