Impact of selective laser ablation of placental anastomoses on the cardiovascular pathology of the recipient twin in severe twin-twin transfusion syndrome - 20/08/11
, Fawaz Alkazaleh, MD b, †, Brian W. McCrindle, MD a, Anita Roberts, BSc, RDCS a, Olena Berezovska, MD b, Rory Windrim, MB b, P. Gareth Seaward, MB, BCh b, Jeffrey F. Smallhorn, MB, BS a, Greg Ryan, MB b
Reprint requests: Lisa K. Hornberger, UCSF, Pediatric Echocardiography Lab and Fetal Cardiovascular Program, 505, Parnassus Avenue, room M-306, San Francisco CA 94143.Abstract |
Objectives |
We investigated the impact of selective laser ablation on the cardiovascular pathology of the recipient twin in twin-twin transfusion syndrome.
Study design |
Fetal echocardiograms and medical records were reviewed from 22 pregnancies with severe twin-twin transfusion syndrome where echocardiography was performed before and after laser.
Results |
Before laser, cardiomegaly associated with right and/or left ventricular hypertrophy without ventricular dilatation, was observed in most cases. Right ventricular and left ventricular systolic dysfunction (shortening fraction <28%) was present in 59% and 27%, respectively, and diastolic dysfunction (based on inflow and venous Dopplers) in 73%. Shortly after laser, biventricular systolic function improved significantly and diastolic function tended to improve (50%, P = .06). Functional pulmonary atresia, secondary to right ventricular systolic dysfunction, resolved in 2 of 2 cases at post-laser echocardiography. On serial assessment, diastolic function was normal in 7 of 10, hydrops regressed in 4 of 5, and neither progressive myocardial hypertrophy nor anatomical right ventricular outflow obstruction were found.
Conclusions |
Selective laser ablation in severe twin-twin transfusion syndrome acutely improves biventricular systolic function and tends to improve diastolic function in the recipient twin.
Le texte complet de cet article est disponible en PDF.Key words : Cardiomyopathy, Fetal echocardiography, Hydrops fetalis, Laser, Twin-twin transfusion syndrome
Plan
| Supported in part by the Physician’s Services Incorporated Foundation, grant n 78390 and by the Foundation “Saint Luc,” Cliniques Universitaires Saint Luc, UCL, Brussels, Belgium. |
Vol 195 - N° 5
P. 1388-1395 - novembre 2006 Retour au numéro
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