Congenital heart disease in twin-to-twin transfusion syndrome treated with fetoscopic laser surgery.
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.
Lopriore
Enrico
E
Division of Neonatology, Department of Pediatrics, Leiden University Medical Center, Leiden, The Netherlands. e.lopriore@lumc.nl
Bökenkamp
Regina
R
Rijlaarsdam
Marry
M
Sueters
Marieke
M
Vandenbussche
Frank P
FP
Walther
Frans J
FJ
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*
D019332:Endothelin-1