Impact of selective laser ablation of placental anastomoses on the cardiovascular pathology of the recipient twin in severe twin-twin transfusion syndrome.
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.
Barrea
Catherine
C
Department of Pediatrics, Division of Cardiology, Fetal Cardiac Program, The Hospital for Sick Children, University of Toronto, Ontario, Canada.
Hornberger
Lisa K
LK
Alkazaleh
Fawaz
F
McCrindle
Brian W
BW
Roberts
Anita
A
Berezovska
Olena
O
Windrim
Rory
R
Seaward
P Gareth
PG
Smallhorn
Jeffrey F
JF
Ryan
Greg
G
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