Profiling fetal cardiac function in twin-twin transfusion syndrome.
OBJECTIVE
Cardiomyopathy in the recipient twin is a marker of severity in twin-twin transfusion syndrome (TTTS), making it a potentially valuable tool for staging the disease. This study aimed to provide a quantitative description of cardiac function in the recipient twin.


METHODS
Consecutive monochorionic pregnancies complicated with TTTS and treated by percutaneous laser coagulation underwent fetal echocardiography before surgery. An unsupervised classification analysis was conducted to identify groups of twins with similar cardiac profiles. The predictive value of the recipient twin's preoperative cardiac function based on these profiles was assessed, using perinatal death of at least one twin as the main outcome. The cardiac function profiles that we identified were compared with the current Quintero staging.


RESULTS
A total of 107 pregnancies were included, with six of these lost to follow-up; 63/107 complete cases were available for multivariate description of the recipient's cardiac function. Three different preoperative cardiac profiles were identified with increasing right and left myocardial performance index, decreasing right and left shortening fraction, and increasing ductus venosus pulsatility index. Although the three groups represented progressive stages of the syndrome-related cardiomyopathy, no correlation was found with pregnancy outcome. Of Quintero Stage 1 cases, 55% showed significant alterations of cardiac function in the recipient twin.


CONCLUSIONS
Progressive cardiomyopathy can be assessed quantitatively in the recipient twin and does not influence pregnancy outcome when fetoscopic laser coagulation is the first-line treatment. Compared with the current staging, cardiac profiling allows discrimination of cases with significant myocardial dysfunction.
Stirnemann
J J
JJ
Department of Obstetrics and Gynecology, GHU Necker Enfants Malades, University Paris Descartes, Paris, France.
Mougeot
M
M
Proulx
F
F
Nasr
B
B
Essaoui
M
M
Fouron
J C
JC
Ville
Y
Y
D001783:Blood Flow Velocity / Q000502:physiology; D009202:Cardiomyopathies / Q000000981:diagnostic imaging* / Q000196:embryology / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D005318:Fetal Heart / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery; D005330:Fetofetal Transfusion / Q000000981:diagnostic imaging* / Q000196:embryology / Q000503:physiopathology; D005865:Gestational Age; D006801:Humans; D017075:Laser Coagulation; D011247:Pregnancy; D011379:Prognosis; D014427:Twins; D016216:Ultrasonography, Prenatal