Intertwin cardiac status at 10-year follow-up after intrauterine laser coagulation therapy of severe twin–twin transfusion syndrome: comparison of donor, recipient and normal values

Herberg, Ulrike; Bolay, Julian; Graeve, P.; Hecher, Kurt; Bartmann, Peter; Breuer, Johannes

doi:10.1136/archdischild-2013-305034

Cited by 29 publications

(22 citation statements)

References 30 publications

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“…5 Some longer term follow-up studies conducted on TTTS survivors beyond the first year of life demonstrate no impact on LV or RV function. 16,17 However, early neonatal data on the post natal adaptation of myocardial performance of the recipient infant, the association with clinical instability after birth, response to therapeutic intervention and long-term outcomes does not exist to date.…”

Section: Discussionmentioning

confidence: 96%

Treatment of premature infants with pulmonary hypertension and right ventricular dysfunction with milrinone: a case series

et al. 2014

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Section: Discussionmentioning

confidence: 96%

Treatment of premature infants with pulmonary hypertension and right ventricular dysfunction with milrinone: a case series

et al. 2014

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“…Right ventricle hypertrophy may lead to obstruction of the outflow tract and, consequently, to decrease in forward flow across the pulmonary valve, causing decreased growth and PS [21] . Additionally, severe systolic dysfunction of the right ventricle may further decrease the blood flow across the outflow tract and even lead to inability to open the pulmonary valve, thus resulting in a functional PA. Endothelin-1 could play a key role, since it is not only a potent vasoconstrictor but also a mitogenic factor which can induce fetal ventricular myocyte proliferation in vitro [22] .…”

Section: Discussionmentioning

confidence: 99%

Rate and Outcomes of Pulmonary Stenosis and Functional Pulmonary Atresia in Recipient Twins with Twin-Twin Transfusion Syndrome

et al. 2016

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Objective: To evaluate the rate of pulmonary stenosis and functional pulmonary atresia (PS/PA) in recipient twins prior to fetal surgery for twin-twin transfusion syndrome (TTTS) and their pre- and postnatal outcomes. Methods: We carried out a prospective study including 260 cases of TTTS. Echocardiography was performed before laser surgery to detect the presence of PS/PA. The outcomes of recipients with and without PS/PA were compared. The need of postnatal cardiac interventions and the survival rate at 6 months of age were also evaluated. Results: PS was observed in 16/260 (6.2%) of recipient twins and PA in 12/260 (4.6%). After fetal surgery, 10/28 (35.7%) recipients died, 9/28 (32.1%) showed in utero regression, and 9/28 (32.1%) had persistence of PS/PA. Postnatally, seven recipients underwent percutaneous balloon pulmonary valvuloplasty, one required surgical valvotomy and one palliative surgery. Pregnancies with recipient twins with PS/PA had lower survival of at least one twin (67.9 vs. 83.6%, p = 0.045) and lower overall survival (57.1 vs. 72.8%, p = 0.015) at 6 months of age. Conclusion: PS and PA were observed in 10.8% of recipients. Among these, about one third showed persistence of pulmonary valve pathology after delivery, which stresses the need for strict follow-up.

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“…Several pathways of RVOTO development have been suggested, such as the underdevelopment of the pulmonary valve due to decreased forward flow across the PV, caused by right ventricular hypertrophy, the effect of endothelial damage caused by shear stress, which eventually results in valve dysplasia and damage of the valve due to exposure to abnormal concentrations of vasoactive mediators such as endothelin‐1, renin, and angiotensin II . The decreased flow across the PV may be explained by impaired cardiac function at the time of TTTS .…”

Section: Commentsmentioning

confidence: 99%

Acquired right ventricular outflow tract obstruction in twin‐to‐twin transfusion syndrome; a prospective longitudinal study

et al. 2018

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Objective The pathophysiology of right ventricular outflow tract obstruction (RVOTO) in twin‐to‐twin transfusion syndrome (TTTS) recipients is incompletely understood. We aimed to investigate the development and spectrum of RVOTO in TTTS recipients. Methods A prospective longitudinal cohort study was conducted between 2015 and 2017. Echocardiographic assessment was performed in recipients from TTTS diagnosis until the neonatal period. Results Prenatal RVOTO, defined as abnormal flow velocity waveforms across the pulmonary valve (PV), was diagnosed in 12.9% (16/124) of recipients at TTTS diagnosis. Postnatal RVOTO was found in 6.7% (7/105) of surviving recipients. All recipients with severe postnatal RVOTO showed prenatal RVOTO at TTTS diagnosis. In 5.6% (6/108) of cases, prenatal RVOTO appeared only after laser therapy, and in 1.9% (2/108), this progressed to mild postnatal pulmonary stenosis. Elevated peak systolic PV velocities were more frequently associated with postnatal RVOTO compared with prenatal finding of functional pulmonary atresia. Postnatal RVOTO was associated with early manifestation of TTTS but was equally found in all Quintero stages. Conclusion In the spectrum of postnatal RVOTO, severe cases show prenatal RVOTO at TTTS diagnosis. However, RVOTO can develop after laser or even in the neonatal period and in all Quintero stages. A potential risk factor for postnatal RVOTO is early TTTS manifestation.

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Intertwin cardiac status at 10-year follow-up after intrauterine laser coagulation therapy of severe twin–twin transfusion syndrome: comparison of donor, recipient and normal values

Abstract: Despite severe prenatal cardiac involvement, childhood cardiac function is normal in the majority of surviving donors and recipients after successful LC of severe TTTS. This underlines the favourable impact of intrauterine LC on postnatal cardiovascular performance.

Cited by 29 publications

References 30 publications

Treatment of premature infants with pulmonary hypertension and right ventricular dysfunction with milrinone: a case series

Treatment of premature infants with pulmonary hypertension and right ventricular dysfunction with milrinone: a case series

Rate and Outcomes of Pulmonary Stenosis and Functional Pulmonary Atresia in Recipient Twins with Twin-Twin Transfusion Syndrome

Acquired right ventricular outflow tract obstruction in twin‐to‐twin transfusion syndrome; a prospective longitudinal study

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