Different expressions of cardiac biomarkers between different types of acquired right ventricular outflow tract abnormality in monochorionic twins

Abstract

Objective: To investigate the differences in amniotic fluid cardiac biomarkers and clinical features among types of right ventricular outflow tract (RVOT) abnormality in monochorionic (MC) twins.Method: This prospective study included MC twins that underwent laser surgery.Recipient or larger twins (group A) and donor or smaller twins (group B) were assessed and divided into those with a normal right ventricular outflow tract (normal RVOT), functional pulmonary atresia (fPA), or pulmonary stenosis (PS). Amniotic fluid levels of NT-proBNP (afNT-proBNP) and cardiac troponin T (afTnT) were examined during surgery.Results: Of 190 fetuses in group A, there were 14 RVOT abnormality cases (including 7 fPA and 7 PS). No group B fetuses showed RVOT abnormality findings.In group A, later and earlier gestational age at surgery were observed in fPA (25.1 � 2.8 weeks) and PS groups (17.8 � 0.9 weeks). All survived PS cases demonstrated progressive pulmonary valve obstruction, not observed in fPA groups. AfNT-proBNP were significantly higher in fPA and PS than in the normal RVOT group (p < 0.05). AfTnT was significantly higher in group A with PS than fPA and normal RVOT groups (p < 0.05). Conclusion:Among RVOT abnormality types in group A, amniotic fluid cardiac biomarkers were differently expressed, and clinical features were also differentiated. These findings provide insight into the pathophysiological influence on RVOT in MC twins. Clinical trial registration:This study was registered with the Japanese Clinical Trial Registry "UMIN-CTR" (http://www.umin.ac.jp/ctr/index-j.htm; trial ID numbers UMIN000024486 and 000037702). Key pointsWhat's already known about this topic? � Right ventricular outflow tract (RVOT) abnormality in monochorionic (MC) twins with complications, such as twin-to-twin transfusion syndrome and selective intrauterine growth restriction, is much more frequent than in singleton fetuses and is a clinically important

Right ventricular outflow tract obstruction in twin‐to‐twin transfusion syndrome undergoing laser surgery: A systematic review and meta‐analysis

“…Management options of TTTS include fetoscopic laser photocoagulation (FLP), amnioreduction, septostomy, selective reduction and expectant management, 5 with FLP being the standard care of management leading to increase in survival 6 . FLP disrupts the adverse feto‐fetal hemodynamic communications, 7 thereby blocking the flow of vasoactive mediators from the donor to the recipient twin. Even though RVOTO regression has been achieved following FLP in many cases in recipient twins, persistence can still be seen, requiring postnatal cardiac intervention procedures 1 …”