Impact of selective laser ablation of placental anastomoses on the cardiovascular pathology of the recipient twin in severe twin-twin transfusion syndrome

Profiling fetal cardiac function in twin–twin transfusion syndrome

“…As reported in earlier studies 29 , UA-PI was raised in both donor and recipient twins, and DV abnormalities were more prevalent in the recipient than in the donor twin. Consistent with the findings of Barrea et al 22 , cardiac function in the overall donor population was grossly normal and they only showed signs of placental insufficiency on peripheral Doppler findings.…”

“…None of these cases had undergone any form of treatment before laser surgery. The median gestational at diagnosis was 20 (IQR, [18][19][20][21][22] weeks. Quintero Stages I and III cases were the most numerous in our study population, and there were very few Stage IV cases and no Stage V cases.…”

“…RV systolic function, diastolic function and MPI in both ventricles were impaired 21,22,27,28 . As reported in earlier studies 29 , UA-PI was raised in both donor and recipient twins, and DV abnormalities were more prevalent in the recipient than in the donor twin.…”

Role of quantitative assessment in fetal echocardiography

“…Understanding the individual functional factors that influence the myocardial performance index is critical in defining the true pathophysiology and course of this disease, as we have previously demonstrated in fetal Ebstein anomaly of the tricuspid valve, in which prolonged isovolumic relaxation time (an index of diastolic function) correlates strongly with shorter ejection times with no abnormality of isovolumic contraction 21 . Insight into disease progression may be further gleaned through the evaluation of many parameters of function and the timing and order of resolution of pathology following intervention, as has been observed in TTTS following laser therapy 22 . Still, creation of a simplified cardiovascular profile score in the standardization of assessments would potentially facilitate diagnosis and serial assessment before and after intervention and the evaluation of treatment strategies in larger cohorts of affected pregnancies.…”

Fetal Echocardiography and Prenatal Cardiovascular Interventions – An Update (2012)

“…In this state, vascular connections between the twins through a shared placenta, an artery from a typically growth restricted donor feeding one or more placental cotyledons of the recipient result in a cascade of events that include evolution of biventricular hypertrophy, high systemic blood pressure, diastolic dysfunction, atrioventricular valve insufficiency, late systolic dysfunction and eventual hydrops in the recipient twin [94,95,115]. That the vascular connections are critical to this clinical picture is suggested by resolution of the cardiovascular pathology in the recipient twin with successful laser ablation of these connections [115]. The latter includes resumption of forward flow through the pulmonary outflow tract in the recipient fetus with pseudopulmonary atresia secondary to severe right ventricular dysfunction.…”