title: Assessment of cardiac function in monochorionic diamniotic twin pregnancies with twin-to-twin transfusion syndrome before and after fetoscopic laser photocoagulation using Speckle tracking.
abstract: OBJECTIVE
  To assess cardiac function with Speckle tracking in fetuses with twin-to-twin transfusion syndrome (TTTS) before and after laser therapy.
  
  
  METHODS
  A prospective case control study was conducted on 11 monochorionic diamniotic twin pairs with TTTS. Based on normal curves derived from healthy controls, global systolic longitudinal myocardial velocity, strain and strain rate values were transformed to z-scores.
  
  
  RESULTS
  Right and left ventricular systolic global strain (-27.45 % and -22.41 %) and strain rate (-4.13/sec and -3.27/sec) were reduced in recipients compared with normal values and all parameters tended to decrease even more after treatment (RV and LV: strain -23.79 % and -20.21 %; strain rate: -3.67/sec and -2.87/sec). The corresponding measurements in donor fetuses revealed no statistical difference compared to reference values.
  
  
  CONCLUSIONS
  The global systolic myocardial function of donor twins before and after laser therapy was in the normal ranges. In contrast, recipient twins exhibited global cardiac dysfunction with decreased pre- and postoperative strain and strain rate. Speckle tracking can identify compromised ventricular myocardial function in fetuses with TTTS.
authors.affiliation: Deparment of Obstetrics and Prenatal Medicine, University Hospital, Bonn, Germany. arnewillruth@hotmail.com
authors.forename: A
authors.initials: A
authors.lastname: Willruth
authors.forename: A
authors.initials: A
authors.lastname: Geipel
authors.forename: C
authors.initials: C
authors.lastname: Berg
authors.forename: R
authors.initials: R
authors.lastname: Fimmers
authors.forename: U
authors.initials: U
authors.lastname: Gembruch
mesh_terms: D000650:Amnion / Q000000981:diagnostic imaging*; D001783:Blood Flow Velocity / Q000502:physiology; D016022:Case-Control Studies; D002823:Chorion / Q000000981:diagnostic imaging*; D004200:Diseases in Twins / Q000000981:diagnostic imaging* / Q000601:surgery*; D018618:Echocardiography, Doppler, Color / Q000379:methods*; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D005330:Fetofetal Transfusion / Q000000981:diagnostic imaging* / Q000601:surgery*; D005332:Fetoscopy / Q000379:methods*; D005865:Gestational Age; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods*; D007231:Infant, Newborn; D053685:Laser Therapy / Q000379:methods*; D009200:Myocardial Contraction / Q000502:physiology*; D011183:Postoperative Complications / Q000000981:diagnostic imaging; D011247:Pregnancy; D011272:Pregnancy, Multiple / Q000502:physiology*; D011446:Prospective Studies; D012016:Reference Values; D013599:Systole / Q000502:physiology; D016896:Treatment Outcome; D016216:Ultrasonography, Prenatal / Q000379:methods*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000601:surgery