title: Selective Reduction Using Intravascular Potassium Chloride Injection after Laser Surgery for Twin-Twin Transfusion Syndrome.
abstract: Selective reduction (SR) via intravascular potassium chloride (KCl) injection is contraindicated in monochorionic twins due to the presence of placental vascular communications, which may serve as a conduit for inter-twin passage of KCl or allow exsanguination of the living twin into the demised twin. After successful selective laser photocoagulation of communicating vessels (SLPCV) for twin-twin transfusion syndrome (TTTS), the twins' circulatory systems are rendered independent. Theoretically, intravascular KCl injection into one twin after successful SLPCV should not result in passage of the feticidal agent nor cause hemodynamic alterations in the co-twin. We describe 3 cases of 1,069 patients (0.3%) that underwent SLPCV for TTTS between 2003 and 2013 and subsequent SR. SLPCV was successfully completed at 180, 226, and 230 weeks' gestational age for Quintero stages III, IV, and III TTTS, respectively. SR via intravascular KCl injection was later performed at maternal request due to the risk of neurological compromise in one twin at 226, 254, and 236 weeks' gestational age. All co-twins survived after SR, and no neurological sequelae were suspected after birth. Further study is necessary before SR can be routinely considered after laser surgery for TTTS.
authors.affiliation: Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, Keck School of Medicine, University of Southern California, Los Angeles, Calif., USA.
authors.forename: Ramen H
authors.initials: RH
authors.lastname: Chmait
authors.forename: Eftichia V
authors.initials: EV
authors.lastname: Kontopoulos
authors.forename: Marc
authors.initials: M
authors.lastname: Jackson
authors.forename: Janet
authors.initials: J
authors.lastname: Horenstein
authors.forename: Ilan
authors.initials: I
authors.lastname: Timor-Tritsch
authors.forename: Rubén A
authors.initials: RA
authors.lastname: Quintero
mesh_terms: D000328:Adult; D005260:Female; D005330:Fetofetal Transfusion / Q000601:surgery*; D006801:Humans; D008028:Light Coagulation; D011189:Potassium Chloride / Q000008:administration & dosage / Q000627:therapeutic use*; D011247:Pregnancy; D018607:Pregnancy Reduction, Multifetal / Q000379:methods*
chemical_list: D011189:Potassium Chloride