title: Congenital heart disease in twin-to-twin transfusion syndrome treated with fetoscopic laser surgery.
abstract: OBJECTIVE
  To determine the incidence of congenital heart disease (CHD) and right ventricular outflow tract obstruction (RVOTO) in twin-to-twin transfusion syndrome (TTTS) treated with fetoscopic laser surgery and evaluate the role of increased afterload by determining the difference in blood pressure and endothelin-1 at birth between donor and recipient twins.
  
  
  METHODS
  Prospective study.
  
  
  METHODS
  Tertiary medical center, serving as the national referral center for fetoscopic laser surgery for TTTS in The Netherlands.
  
  
  METHODS
  All consecutive cases of monochorionic twins with TTTS treated with laser (n = 46 twin pairs) and monochorionic twins without TTTS (n = 55 twin pairs) delivered at our center between June 2002 and June 2005 were included in the study.
  
  
  METHODS
  Echocardiography was performed within 1 week after delivery. At birth, blood pressure was measured in all survivors and endothelin-1 was determined in umbilical cord blood. Data on RVOTO in TTTS treated with laser surgery at our center but delivered elsewhere were reviewed retrospectively from medical records.
  
  
  RESULTS
  The incidence of CHD in the TTTS group and non-TTTS group was 5.4% (4/74) and 2.3% (2/87) (P = .42), respectively. RVOTO was diagnosed in 1 recipient twin delivered at our center and 2 recipient twins delivered elsewhere. The incidence of RVOTO in recipients was 4% (3/75). Mean systolic blood pressure at birth was similar in donor and recipient twins, respectively, 53 mm Hg vs. 56 mm Hg (P = .42). Mean endothelin-1 level at birth was also similar between donors and recipients, respectively, 14.3 ng/L and 13.2 ng/L (P = .64).
  
  
  CONCLUSIONS
  The incidence of CHD in TTTS treated with fetoscopic laser surgery is higher than in the general population (5.4% vs. 0.5%). We found no difference in afterload parameters between donors and recipients after laser treatment.
authors: Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands. e.lopriore@lumc.nl
authors: Enrico
authors: E
authors: Lopriore
authors: Regina
authors: R
authors: Bökenkamp
authors: Marry
authors: M
authors: Rijlaarsdam
authors: Marieke
authors: M
authors: Sueters
authors: Frank P
authors: FP
authors: Vandenbussche
authors: Frans J
authors: FJ
authors: Walther
mesh_terms: D001794:Blood Pressure; D004200:Diseases in Twins; D004452:Echocardiography; D019332:Endothelin-1 / Q000097:blood; D005260:Female; D005330:Fetofetal Transfusion / Q000150:complications*; D005332:Fetoscopy; D006330:Heart Defects, Congenital / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D053685:Laser Therapy / Q000379:methods*; D008297:Male; D011247:Pregnancy; D011446:Prospective Studies; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*
chemical_list: D019332:Endothelin-1