Differential Changes in Myocardial Performance Index and Its Time Intervals in Donors and Recipients of Twin-to-Twin Transfusion Syndrome before and after Laser Therapy

Ortiz, JU; Torres, X.; Eixarch, Elisenda; Bennásar, M.; Cruz‐Lemini, M.; Gómez, O.; Lobmaier, Silvia M.; Martínez, Josep M.; Gratacós, E.; Crispi, F.

doi:10.1159/000485380

Cited by 13 publications

(24 citation statements)

References 33 publications

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“…Interestingly, LV ICT’ was decreased in LUTO fetuses (group 1) compared with controls, and for the RV, there even was no difference between LUTO fetuses and controls. However, in the setting of high afterload, it would be expected that ICT’ increases as it is described for TTTS recipient twins …”

Section: Discussionmentioning

confidence: 99%

Myocardial function in fetuses with lower urinary tract obstruction: Is there a cardiac remodeling effect due to renal damage?

et al. 2019

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Objectives: Cardiac remodeling due to renal dysfunction may have an impact on myocardial function (MF) of fetuses with lower urinary tract obstruction (LUTO).The aim was to identify possible differences in MF in LUTO fetuses compared with healthy controls and to look for interactions between urine biochemistry and MF indices.Methods: This is a cohort study consisting of 31 LUTO fetuses and 45 healthy controls. Subgroups were generated according to intrauterine therapy (group 1: LUTO after therapy, group 2: LUTO without therapy at the time of examination, and group 3: controls). MF indices were measured using pulsed wave tissue Doppler imaging and M-mode. Furthermore, results of fetal urine biochemistry were gathered retrospectively.

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Section: Discussionmentioning

confidence: 99%

Myocardial function in fetuses with lower urinary tract obstruction: Is there a cardiac remodeling effect due to renal damage?

et al. 2019

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“…This parameter evaluates both systolic and diastolic myocardial function representing the quotient of the sum of the duration of isovolumetric contraction time (ICT) and isovolumetric relaxation time (IRT) divided by the ejection time (ET). Prolonged ICT, IRT and higher MPI are found in recipients at all TTTS stages due to a slow chronic increase in volume load with increased ventricular dimensions [40]. An important atrioventricular valve regurgitation is present and often extending throughout more than half of the cardiac cycle [41,42].…”

Section: Recipient Cardiovascular Pathophysiologymentioning

confidence: 99%

“…In addition, pressure overload, the result of the release of vasoactive factors in the donor twin (such as angiotensin II and endothelin I, which are also transferred to the recipient twin through vascular anastomoses) determines hypertrophic cardiomyopathy and right ventricular outflow tract abnormalities in the recipient [43]. Major changes in preload and afterload could lead to decreased ventricular strain of both ventricles in recipient in the early stages of TTTS [40].…”

Section: Recipient Cardiovascular Pathophysiologymentioning

confidence: 99%

“…In the donor, rapid increase in left ventricular filling pressure, volume and cardiac output result in reappearance of end-diastolic flow in the UA and a significant increase of pulsatility index after the procedure [40]. Umbilical venous flow is increased by more than 50% in donor within 48 hours of SFLP and improved renal perfusion is reflected by reappearance of bladder filling [64].…”

Section: Antenatal Therapy and Its Implication On The Cardiovascular mentioning

confidence: 99%

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Fetal cardiovascular alterations in twin-to-twin transfusion syndrome

Rotar

Zaharie

Staicu

et al. 2020

Medicine and Pharmacy Reports

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Twin-to-twin transfusion syndrome (TTTS) is the consequence of vascular anastomoses of the shared placenta of monochorionic twin pregnancies. Both circulating inter-twin blood flow and vasoactive mediators imbalance cause hypovolemia in the donor and hypervolemia in the recipient fetus. If left untreated, TTTS has a high perinatal mortality rate and adverse long-term outcomes mainly cardiovascular and neurological. The recipient has cardiovascular changes including atrioventricular valve regurgitation, diastolic dysfunction and pulmonary stenosis/atresia. The maladaptive response to vascular changes determines a constant decreased blood flow in the donor that permanently modifies the arterial structure leading to postnatal alterations in the vascular system. Fetoscopic LASER surgery of placental vascular anastomoses may disrupt the underlying pathophysiology and improves cardiovascular function with normalization of systolic and diastolic function within weeks after treatment. The impact of cardiovascular changes is relevant for the safety of the management of a TTTS case. The improvement of the perinatal survival after intrauterine surgery leads to viable infants with the longer-term sequelae. Therefore accurate quantification of cardiovascular involvement is essential for clinicians for pregnancy management but also for patient counseling about the potential treatment options the outcome.

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“…In fetal life, fetal myocardial performance has been investigated in many fetal and maternal diseases (diabetes mellitus, twin-to-twin transfusion syndrome, intrauterine growth restriction, fetal hematological diseases, fetal congenital cardiac and thoracal diseases, and fetal chromosomal abnormalities) that are thought to theoretically affect myocardial performance in the fetuses [4][5][6][7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

Does Down Syndrome Have an Effect on Impaired Myocardial Performance in Fetuses with Increased Nuchal Translucency?

Sezer

Kaya

Behram

et al. 2020

Preprint

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Objective: We aimed to evaluate myocardial performance in fetuses with increased nuchal translucency. Method: Cases with increased NT without any associated structural anomalies were enrolled in this study. The study group consisted of 53 pregnancies complicated with thickened NT > 3.5 mm. Forty-six gestational age-matched pregnant women whose fetuses had normal NT thickness were enrolled in the study as the control group. The TEI index was evaluated before performing CVS in the group with an increase in NT. Karyotype analysis was performed via CVS in all patients with increased NT. In both groups, detailed fetal sonographic examinations, including fetal echocardiograms, were performed between 18 and 24 weeks of gestation. Results: The differences between normal and increased NT groups in terms of isovolumetric relaxation time (IRT), ejection time (ET), and myocardial performance index (MPI) variables were found to be statistically significant (p values of 0.023, 0.004, and < 0.001, respectively). For IRT and MPI variables, the median values of the group with an increase in NT were found to be significantly higher than that of the normal NT group, whereas the median value of the ET variable of the group with increased NT was significantly lower than that of the normal NT group Conclusion: The MPI significantly increased in the group with increased NT, but no difference was observed between those with and without Down syndrome. This suggests that increased NT is caused by cardiac dysfunction, whether or not Down syndrome is present.

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Differential Changes in Myocardial Performance Index and Its Time Intervals in Donors and Recipients of Twin-to-Twin Transfusion Syndrome before and after Laser Therapy

Cited by 13 publications

References 33 publications

Myocardial function in fetuses with lower urinary tract obstruction: Is there a cardiac remodeling effect due to renal damage?

Myocardial function in fetuses with lower urinary tract obstruction: Is there a cardiac remodeling effect due to renal damage?

Fetal cardiovascular alterations in twin-to-twin transfusion syndrome

Does Down Syndrome Have an Effect on Impaired Myocardial Performance in Fetuses with Increased Nuchal Translucency?

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