title: Thrombosis of anastomoses may affect the staging sequence of twin-twin transfusion syndrome.
abstract: Twin-twin transfusion syndrome (TTTS) is a severe complication of monozygotic (identical) twins, which share one single monochorionic placenta. It is caused by placental anastomoses which link the two fetoplacental circulations of the twins and allow a chronic net inter-twin transfusion to develop between the fetuses. Clinical presentation of TTTS manifestations has been classified into five different stages. In this paper, we used our computational model of TTTS and examined the possible differences between chronic and rapidly increasing inter-twin transfusion in the simulated TTTS staging sequence. Our results suggest that rapid alterations in the net inter-twin transfusion, e.g. due to thrombosis of placental anastomoses, may produce a different staging sequence than in TTTS caused by chronic inter-twin transfusion. These results may aid an improved knowledge of TTTS pathophysiology under conditions of a rapidly changing cardiovascular function, and contribute to the planning of optimal intervention under such circumstances.
authors.affiliation: Laser Center, Academic Medical Center-University of Amsterdam, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands. j.p.vandenwijngaard@amc.uva.nl
authors.forename: Jeroen P H M
authors.initials: JP
authors.lastname: van den Wijngaard
authors.forename: Michael G
authors.initials: MG
authors.lastname: Ross
authors.forename: Martin J C
authors.initials: MJ
authors.lastname: van Gemert
mesh_terms: D001163:Arteriovenous Anastomosis / Q000473:pathology* / Q000503:physiopathology*; D003198:Computer Simulation; D005260:Female; D005330:Fetofetal Transfusion / Q000473:pathology* / Q000503:physiopathology*; D005333:Fetus / Q000098:blood supply / Q000473:pathology / Q000503:physiopathology; D006801:Humans; D008297:Male; D008954:Models, Biological; D011247:Pregnancy; D013927:Thrombosis / Q000473:pathology* / Q000503:physiopathology*; D013997:Time Factors; D038522:Twinning, Monozygotic