Endoscopic laser surgery versus serial amniocenteses in the treatment of severe twin-twin transfusion syndrome

Hecher, Kurt; Plath, H.; Bregenzer, Thomas; Hansmann, M.; Hackelöer, Bernhard-Joachim

doi:10.1016/s0002-9378(99)70278-4

Cited by 308 publications

(217 citation statements)

References 17 publications

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“…21 If such factors are produced by the placenta, they would no longer be present after delivery, which would explain the observed postnatal regression of the disease, much like the HCM in infants of diabetic mothers. Serial amniocenteses and endoscopic laser ablation of placental vascular anastomoses improve outcome of affected pregnancies 22,23 ; however, their affect on the cardiovascular manifestation has not been fully delineated.…”

Section: Extrinsic Causes Of Fetal CMmentioning

confidence: 99%

Fetal Cardiomyopathies

et al. 2002

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Background-Although the prenatal diagnosis of most fetal structural heart defects and dysrhythmias has been described, there is a paucity of information about cardiomyopathies (CMs) in prenatal life. Methods and Results--To determine the pathogenic mechanisms, hemodynamic findings, and outcome of fetal CM, we reviewed the fetal echocardiograms and perinatal histories of 55 affected fetuses. Dilated CM was diagnosed in 22 cases, including 2 with congenital infections, 5 familial cases, 6 with endocardial fibroelastosis related to maternal anti-Ro/La antibodies, and 9 idiopathic cases. Thirty-three had hypertrophic CM, 7 associated with maternal diabetes, 2 with Noonan's syndrome, 2 with ␣-thalassemia, 18 with twin-twin transfusion syndrome, 1 with familial hypertrophy, and 3 with idiopathic hypertrophy. Systolic dysfunction was present in all cases of dilated CM and 15 cases of hypertrophic CM. Diastolic dysfunction was present in 19 of 30 fetuses with assessment of diastolic function parameters. Significant mitral or tricuspid valve regurgitation was seen in 32 cases. Eight fetuses were hydropic and 23 had signs of early hydrops. Seven pregnancies were terminated. Of 46 continued pregnancies with follow-up, 29 (63%) died perinatally. The presence of systolic dysfunction, diastolic dysfunction, and significant atrioventricular valve regurgitation were identified as risk factors for mortality. By multiple logistic regression, diastolic dysfunction was associated with an 8-fold increased risk relative to the other parameters. Conclusions-Fetal CM has a broad spectrum of intrinsic and extrinsic causes. A poor outcome is observed in many affected fetuses. Diastolic dysfunction in fetal CM is associated with the highest risk of mortality. (Circulation. 2002; 106:585-591.)

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Section: Extrinsic Causes Of Fetal CMmentioning

confidence: 99%

Fetal Cardiomyopathies

et al. 2002

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“…The Quintero stage did not worsen in any of the survivors; however, stage III atypical, which was defined as abnormal Doppler flow with visible donor bladder, had a decreased survival rate especially in 2 survivors. Table 4 presents the perinatal outcomes in published series including early series of pioneer operators [1,[17][18][19][20] and published data [12,[21][22][23][24]] from the conclusion of the Eurofetus trial comparison to the present study. Early series reported approximately a 60% overall survival rate, a 5% neurological complication rate; and a 40% survival rate of both twins.…”

Section: Resultsmentioning

confidence: 99%

Fetoscopic Laser Photocoagulation for the Treatment of Twin-Twin Transfusion Syndrome in Monochorionic Twin Pregnancies

Murakoshi¹

2012

TOMDJ

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Fetoscopic laser surgery for severe twin-twin transfusion syndrome (TTTS) has become the optimal treatment choice since the release of the Eurofetus randomized clinical trial. These techniques have been adopted throughout the globe, and many institutions have instituted or will soon institute fetoscopic laser surgery procedures; however, laser surgery has a steep learning curve because of the following: challenging placental location, complex and unexpected communicating anastomoses, residual anastomoses after surgery, or discolored amniotic fluid. We have been performing laser surgery since 2002 in Japan; to date, we have compiled a series of 170 cases. Our data indicates a 78% of overall survival with 5% neonatal morbidity, 63% of survival of both twins, and 93% survival of at least one twin. The recurrent TTTS rate was 1% and the residual vessel rate was 3%.To improve the learning curve of laser surgery, the employment of various techniques is recommended to achieve a successful surgical outcome: (1) Mapping: before laser ablation, a very thorough mapping of vascular anastomoses should be done, and should be repeated after ablation; (2) Sequential order: obliteration of arterio-venous anastomoses from donor to recipient should be done first to avoid donor hypotension and/or anemia; (3) Trocar (cannula) assisted technique: Trocar assisted technique: Using gentle indent the trocar to the placenta by withdrawing the scope shortly, then anastomoses could be ablated easily; (4) Line method: to avoid residual anastomoses, the laser should draw a virtual line at the hemodynamic equator; The operator must be careful not to miss small anastomoses.These techniques can help achieve a successful outcome for fetoscopic laser surgery and improve the outcome for cases of severe TTTS.

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“…Recent results have shown better survival for laser therapy, and obliteration of chorionic plate anastomoses could halt the pathophysiological process. [11][12][13] Endoscopic laser ablation is feasible in pregnancies that are complicated by severe fetofetal transfusion syndrome and appears to be associated with improved perinatal outcome. 14 …”

Section: Discussionmentioning

confidence: 99%

“…Resultados: a discordância média (SD) para DBP, CC, CA, CF e peso fetal um dia antes do laser foi 8,53% (5,28), 8,75% (2,76), 16,19% (4,85), 12,92% (5,13) e 28,50% (6,46). No segundo exame pós-laser os resultados foram 4,37% (3,55), 3,73% (2,71), 8,90% (4,42), 6,61% (4,99) e 19,11% (8,01); e a discordância do peso fetal ao nascimento foi 18,55% (8,74 interval between the ultrasound measurements was of at least two weeks.…”

Section: Objetivos: Avaliar Impacto Da Terapia a Laser No Crescimentounclassified

The impact of laser therapy on fetal growth discordance in twin-to-twin transfusion syndrome

Laurent

Takahashi

et al. 2005

Rev. Bras. Saude Mater. Infant.

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Endoscopic laser surgery versus serial amniocenteses in the treatment of severe twin-twin transfusion syndrome

Cited by 308 publications

References 17 publications

Fetal Cardiomyopathies

Fetal Cardiomyopathies

Fetoscopic Laser Photocoagulation for the Treatment of Twin-Twin Transfusion Syndrome in Monochorionic Twin Pregnancies

The impact of laser therapy on fetal growth discordance in twin-to-twin transfusion syndrome

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