Assessment of cardiac function in donor and recipient fetuses during a 7-day follow-up after selective laser photocoagulation of communicating vessels due to TTTS

Abstract

Objectives: The aim of the study was to analyze the changes in cardiac function and myocardial contractility of donor and recipient fetuses with twin-to-twin transfusion syndrome (TTTS) subjected to selective laser photocoagulation of the communicating vessels (SLPCV), between and after the procedure. Finally, we verified if fetuses with Quintero's stage I TTTS presented with early impairment of myocardial contractility. Material and methods: We selected 77 consecutive women with twin pregnancies, whose both fetuses survived at least seven days post-SLPCV. Myocardial contractility of both fetuses was evaluated ultrasonographically, and their myocardial performance indices (Tei-Index values) and shortening fractions (SF) were determined. Results: In donor fetuses, the Tei-Index values for both right and left ventricle remained within the respective reference ranges both before the procedure and during a 7-day follow-up. A significant change in shortening fraction values for the left ventricle in recipient fetuses and the right ventricle of in the donors was observed during a 7-day follow-up. Conclusions: Comparison of the cardiac parameters of donors and recipients revealed significant differences in Tei-indices during the entire follow-up period. The group with Quintero's I stage TTTS included 74% of recipient fetuses with abnormal Tei-Index values for the right ventricle (mean 0.53).

Cardiac adaptation and malformation in twin–twin transfusion syndrome and selective fetal growth restriction: A systematic review

“…25,29 However, early subclinical systolic dysfunction, expressed by decreased longitudinal motion (lower mitral and tricuspid annular plane systolic excursion), has also been documented. 39 As systolic dysfunction progresses, it may become evident in reduced shortening fractions of both ventricles (indicating impaired contraction), primarily observed in the RV 22,23,27,29,37,[40][41][42][43][44][45][46] and decreased strain and strain rate. 26,32,33,47 cardiac output (CO) may be increased.…”

“…38 Global cardiac function, primarily assessed using the MPI, consistently demonstrates higher values in recipients compared with uncomplicated MC twins and/or donors, indicating myocardial dysfunction. Most studies report an elevated MPI of the LV, 22,23,25,27,29,30,36,37,[41][42][43]46,48,[51][52][53][54][55][56][57][58][59][60] because of prolonged isovolumetric times and decreased ejection times. The left MPI increases with Quintero staging, 25,27,30,[35][36][37]41,43,46,48,52,[54][55][56][57][58][59][60] but it might already be elevated in early Quintero stages.…”

“…Most studies report an elevated MPI of the LV, 22,23,25,27,29,30,36,37,[41][42][43]46,48,[51][52][53][54][55][56][57][58][59][60] because of prolonged isovolumetric times and decreased ejection times. The left MPI increases with Quintero staging, 25,27,30,[35][36][37]41,43,46,48,52,[54][55][56][57][58][59][60] but it might already be elevated in early Quintero stages. 32 Deviations in mean cardiac time intervals (decreased relaxation time and increased contraction time) have also been identified in (future)-TTTS recipients, as measured by color-coded Tissue Doppler Imaging.…”

“…After laser surgery, recipients exhibit a rapid improvement in cardiac function, as indicated by different ultrasound parameters, 23,32,35,41,47,52,54,55,59,[71][72][73][74] while donors might show signs of temporary impairment of cardiac function. 55 The reduced forward flow across the PV, causing functional pulmonary atresia, typically resolves shortly after laser therapy, unlike pulmonary stenosis.…”

Ultrasonographic Diagnosis of Twin-to-Twin Transfusion Syndrome

“…Fetal echocardiography may show decreased contractility of the heart muscle accompanied by hypertrophy and cardiomegaly. 24 25 A further increase in circulating blood volume and worsening of polycythemia causes circulatory and heart failure, which is characterized by signs of reflux through fetal tricuspid valve ( Fig. 7 ).…”