Laser for the treatment of twin to twin transfusion syndrome.
OBJECTIVE
To report the initial experience in our country with a new technique for twin to twin transfusion syndrome (TTTS) treatment, using laser to coagulate the placental vessels responsible for the twin transfusion during gestation.


METHODS
Prospective study of eight cases diagnosed with TTTS evaluated in our service from january 2001 to june 2005. Through percutaneous introduction of a 2,0mm diameter fetoscope in the uterine cavity, placental surface vessels where directly visualized. Those identified as responsible for the transfusion were laser coagulated. The procedure combines ultrasonography and fetoscopy, in a so-called sonoendoscopic technique (FETENDO).


RESULTS
Among the eight pregnancies evaluated, five cases were submitted to the procedure (10 fetuses). All fetuses survived for at least five weeks after surgery. A total of eight fetuses were born alive and five survived the neonatal period. In a 18 months follow-up after birth, all five are still alive and well and their mean age is now 10,6 months. The total survival rate was 50% and in three pregnancies, at least one fetus survived.


CONCLUSIONS
Laser fetoscopy is actually the "gold-standard" treatment of TTTS. Nevertheless is a sophisticated technique that depends of proper training. Our service is the first in our country to offer this therapeutic technique. Our success rate is comparable with the international literature.
Pedreira
Denise Araújo Lapa
DA
Albert Einstein Hospital, São Paulo, Brazil. wdpedreira@uol.com.br
Acácio
Gregório Lorenzo
GL
Drummond
Carolina Leite
CL
Oliveira
Rita de Cássia Sanchez e
Rde C
Deustch
Alice D'Agostini
AD
Taborda
Wladimir Guimarães
WG
D005260:Female; D005330:Fetofetal Transfusion / Q000000981:diagnostic imaging / Q000601:surgery*; D005332:Fetoscopy / Q000379:methods*; D005500:Follow-Up Studies; D005865:Gestational Age; D006801:Humans; D017075:Laser Coagulation / Q000379:methods*; D010920:Placenta / Q000098:blood supply; D011247:Pregnancy; D011446:Prospective Studies; D012720:Severity of Illness Index; D014463:Ultrasonography