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Fetal Cardiac Function In Recipient Twins Undergoing Fetoscopic Laser Ablation Of Placental Anastomoses For Stage Iv Twin-Twin Transfusion Syndrome TTTS



Fetal Cardiac Function In Recipient Twins Undergoing Fetoscopic Laser Ablation Of Placental Anastomoses For Stage Iv Twin-Twin Transfusion Syndrome TTTS



Ultrasound in Obstetrics & Gynecology 42(1): n/a-n/a



Cardiac dysfunction is common in the recipient fetus of twin-twin transfusion syndrome (S). In this study, we aimed to document severity of fetal cardiac dysfunction in stage IV S (fetal hydrops) and assess evolution of cardiac function longitudinally after fetoscopic laser.Material & MethodsWe reviewed obstetric ultrasounds, pre- and postoperative echocardiograms and neonatal outcomes for 22 cases of stage IV S undergoing fetoscopic laser ablation of placental anastomoses between 1998 and 201Myocardial performance index, atrio-ventricular valve flow patterns, ventricular shortening fraction, ventricular hypertrophy, outflow tract obstruction and venous Doppler waveforms were assessed. Nineteen fetuses (86%) had ascites, 8 (36%) had pleural effusions, 9 (41%) had a pericardial effusion and 12 (55%) had subcutaneous edema at presentation. Pre-operatively, cardiac function was grossly abnormal in all. Eight fetuses (36%) had functional pulmonary atresia and 1 (4.5%) had functional aortic atresia. Seventy seven percent of recipient fetuses survived until birth. Echocardiographic follow-up (mean 26 days post-operatively) showed that indices of fetal cardiac function improved considerably, however never completely normalised. Six fetuses with functional pulmonary atresia (75%), as well as the fetus with functional aortic atresia, survived to birth. In all cases, the functional atresia resolved within 48 hours of laser and none had structural valve anomalies at birth. All fetal effusions resolved after the laser. Fetoscopic laser ablation of placental anastomoses reverses cardiac dysfunction and valvulopathy, even in the most severe cases of S. Recovery however takes longer than in early stage disease.

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Accession: 036800325

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DOI: 10.1002/uog.12454


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