Treatment of Twin-Twin Transfusion Syndrome by Laser and Digoxin

Abstract

Objectives: A combination of surgical and medical approaches may address both the underlying pathophysiological processes and the most threatening symptoms in twin-twin transfusion syndrome (TTTS). Case: A primigravida with monochorionic twin pregnancy was referred with signs of TTTS at 16 weeks. One twin was severely hydropic with normal amniotic fluid, the co-twin had anhydramnios. Laser treatment was performed. Nevertheless, signs of severe cardiac decompensation in the recipient remained unchanged. After treatment with digoxin restoration of congestive heart failure and a resolution of the hydrops were achieved. Activity and inter-twin contacts increased significantly. At 37 weeks 2 healthy boys were delivered. Postnatal computerangiography of the placenta revealed no arteriovenous anastomoses. Conclusions: This case suggests that a combined causal and symptomatic therapy in cases with cardiac decompensation of the recipient can be beneficial as demonstrated by echocardiography, venous Doppler and behavioral analysis. Computer angiography of the placenta may demonstrate the effect of laser treatment.

Review Paper. Transplacental Digoxin Treatment In Prenatal Cardiac Problems In Singleton Pregnancies - Meta Analysis (Based On Literature: 1992–2015)

“…Jaeggi and co-workers in 1998 and Fouron in 2000 commenced the new era in prenatal SVT treatment based on the selection of the medicine depending on the type of arrhythmias 21,22 . In this review we analyzed the reports focusing on singleton pregnancies, but DeLia and Arabin published about digoxin in twin transfusion syndrome as an addition to laser resulting in foetal improvement 23,24 .…”

“…Digoxin treatment in cases other than SVT was applied in such abnormalities as: in foetuses with Ebstein's anomaly, critical AS , absent pulmonary valve syndrome, complete heart block, in foetuses with aneurysm/diverticulum of left ventricle, in tricuspid atresia or dysplasia, rhabdomyoma, pulmonary atresia, HLHS with fibroelastosis, in twin twin transfusion syndrome and in extracardiac anomalies such as atriovenous malformation or sacrococcygeal teratoma 4,5,6,8,9,10,11,23,24,37,42 .…”

Ultrasound in multiple pregnancy

“…Doppler velocimetry of the ductus venosus in the recipient showed a loss of the D wave before laser treatment and an extreme reverse A-wave in the inferior vena cava, both as a sign of the high preload (Figure 8a, b), and the fiow velocity wave form of the ductus venosus of the donor sbowed a nearly normal pattern signifying a normal afterload (Figure 8c). After laser therapy, we additionally treated the cardiomegaly with transplacental digoxin [38] and the cardiac circumferences became equal with normal venous Doppler velocimetry after 6 weeks. The outcome of the twins bom at 37 weeks was uneventful.…”

Treatment Options for the Twin–Twin Transfusion Syndrome: A Review

“…Roman et al (1995) successfully treated hydropic recipients by using amniocentesis and digoxin. Arabin et al (1998) reported that cardiac decompensation and hydrops were reversible following combined surgical (laser) and medical (digoxin) approaches in a case with congestive heart failure 507 Twin Research Volume 5 Number 6 pp. 507-514…”