Residual anastomoses in twin-to-twin transfusion syndrome treated with selective fetoscopic laser surgery: localization, size, and consequences.
OBJECTIVE
To study the localization and size of residual anastomoses in twin-to-twin transfusion syndrome treated with fetoscopic laser surgery and correlate the findings with outcome.


METHODS
Placental injection in twin-to-twin transfusion syndrome placentas treated with laser was performed by using colored dye.


RESULTS
A total of 77 twin-to-twin transfusion syndrome placentas were included in the study. Residual anastomoses (n = 48) were found in 32% (25/77) of lasered placentas. Most residual anastomoses were localized near the margin of the placenta. The majority of residual anastomoses (67%; 32/48) were very small (diameter, < 1 mm). Eleven of the 25 cases (44%) in the residual anastomoses group developed twin anemia-polycythemia sequence.


CONCLUSIONS
Most residual anastomoses in twin-to-twin transfusion syndrome placentas treated with laser are very small and localized near the placental margin. Almost half of cases with residual anastomoses developed twin anemia-polycythemia sequence after laser surgery.
Lopriore
Enrico
E
Department of Pediatrics, Division of Neonatology, Leiden University Medical Centre, Leiden, The Netherlands.
Slaghekke
Femke
F
Middeldorp
Johanna M
JM
Klumper
Frans J
FJ
Oepkes
Dick
D
Vandenbussche
Frank P
FP
D000328:Adult; D000740:Anemia / Q000473:pathology; D001163:Arteriovenous Anastomosis / Q000601:surgery*; D005260:Female; D005315:Fetal Diseases / Q000473:pathology; D005330:Fetofetal Transfusion / Q000473:pathology / Q000601:surgery*; D005332:Fetoscopy; D005333:Fetus / Q000098:blood supply* / Q000601:surgery*; D006801:Humans; D017075:Laser Coagulation; D010920:Placenta / Q000098:blood supply* / Q000601:surgery; D011086:Polycythemia / Q000473:pathology; D011247:Pregnancy; D014430:Twins, Monozygotic / Q000097:blood