Postoperative middle cerebral artery peak systolic velocity changes confirm physiological principles of the sequential laser technique for twin-twin transfusion syndrome.
BACKGROUND
Treatment of the twin-twin transfusion syndrome (TTTS) via sequential selective laser photocoagulation of communicating vessels (SQLPCV) mandates ablation of donor-to-recipient arteriovenous anastomoses first. It is hypothesized that SQLPCV facilitates intraoperative transfusion to the donor, thereby minimizing donor hypovolemia and anemia. We sought to determine if postoperative changes in fetal middle cerebral artery-peak systolic velocities (MCA-PSV) support this hypothesis.


METHODS
Patients undergoing preferential SQLPCV for TTTS had MCA-PSV measured 1 day before surgery and on postoperative day 1 (POD-1). Fetal anemia was defined as an MCA-PSV ≥1.5 multiples of the median (MoM). Exclusions included: POD-1 demise, missing MCA-PSV data, or gestational age <18 weeks.


RESULTS
Study criteria were met by 139 patients. Mean MCA-PSV in recipients increased from 0.97 to 1.15 MoM postoperatively (p < 0.0001). Donor mean MCA-PSV remained stable at 1.00 MoM preoperatively and 0.98 MoM postoperatively (p = 0.272). Nine fetuses, 6 donors and 3 recipients, had preoperative anemia; SQLPCV was not attempted in the 3 anemic recipients. Postoperatively, the proportion of donors with anemia remained stable (increase 3.6%, p = 0.419), and the proportion of recipients with anemia increased (increase 12.2%, p = 0.009).


CONCLUSIONS
Our findings confirm the presumed physiological basis for the SQLPCV treatment of TTTS.
Pathak
Bhuvan
B
Department of Obstetrics and Gynecology, University of Southern California, Los Angeles, CA 90027, USA. chmait@usc.edu
Quintero
Ruben
R
Kontopoulos
Eftichia
E
Assaf
Samer
S
Miller
David
D
Chmait
Ramen H
RH
D001783:Blood Flow Velocity / Q000502:physiology*; D005260:Female; D005330:Fetofetal Transfusion / Q000503:physiopathology / Q000601:surgery; D005333:Fetus / Q000601:surgery; D005865:Gestational Age; D006801:Humans; D017075:Laser Coagulation / Q000379:methods*; D020768:Middle Cerebral Artery / Q000503:physiopathology*; D011184:Postoperative Period; D011247:Pregnancy; D012189:Retrospective Studies; D016896:Treatment Outcome