title: Impact of selective laser ablation of placental anastomoses on the cardiovascular pathology of the recipient twin in severe twin-twin transfusion syndrome.
abstract: OBJECTIVE
  We investigated the impact of selective laser ablation on the cardiovascular pathology of the recipient twin in twin-twin transfusion syndrome.
  
  
  METHODS
  Fetal echocardiograms and medical records were reviewed from 22 pregnancies with severe twin-twin transfusion syndrome where echocardiography was performed before and after laser.
  
  
  RESULTS
  Before laser, cardiomegaly associated with right and/or left ventricular hypertrophy without ventricular dilatation, was observed in most cases. Right ventricular and left ventricular systolic dysfunction (shortening fraction <28%) was present in 59% and 27%, respectively, and diastolic dysfunction (based on inflow and venous Dopplers) in 73%. Shortly after laser, biventricular systolic function improved significantly and diastolic function tended to improve (50%, P = .06). Functional pulmonary atresia, secondary to right ventricular systolic dysfunction, resolved in 2 of 2 cases at post-laser echocardiography. On serial assessment, diastolic function was normal in 7 of 10, hydrops regressed in 4 of 5, and neither progressive myocardial hypertrophy nor anatomical right ventricular outflow obstruction were found.
  
  
  CONCLUSIONS
  Selective laser ablation in severe twin-twin transfusion syndrome acutely improves biventricular systolic function and tends to improve diastolic function in the recipient twin.
authors.affiliation: Department of Pediatrics, Division of Cardiology, Fetal Cardiac Program, The Hospital for Sick Children, University of Toronto, Ontario, Canada.
authors.forename: Catherine
authors.initials: C
authors.lastname: Barrea
authors.forename: Lisa K
authors.initials: LK
authors.lastname: Hornberger
authors.forename: Fawaz
authors.initials: F
authors.lastname: Alkazaleh
authors.forename: Brian W
authors.initials: BW
authors.lastname: McCrindle
authors.forename: Anita
authors.initials: A
authors.lastname: Roberts
authors.forename: Olena
authors.initials: O
authors.lastname: Berezovska
authors.forename: Rory
authors.initials: R
authors.lastname: Windrim
authors.forename: P Gareth
authors.initials: PG
authors.lastname: Seaward
authors.forename: Jeffrey F
authors.initials: JF
authors.lastname: Smallhorn
authors.forename: Greg
authors.initials: G
authors.lastname: Ryan
mesh_terms: D000328:Adult; D001163:Arteriovenous Anastomosis / Q000601:surgery*; D006332:Cardiomegaly / Q000000981:diagnostic imaging / Q000196:embryology*; D004452:Echocardiography; D005260:Female; D005330:Fetofetal Transfusion / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006331:Heart Diseases / Q000196:embryology* / Q000503:physiopathology; D006801:Humans; D015160:Hydrops Fetalis / Q000503:physiopathology; D053685:Laser Therapy; D010920:Placenta / Q000098:blood supply*; D011247:Pregnancy; D012720:Severity of Illness Index; D014427:Twins; D016276:Ventricular Function