title: Fetal cardiovascular hemodynamics in twin-twin transfusion syndrome.
abstract: Twin-twin transfusion syndrome (TTTS) complicates 10-15% of monochorionic-diamniotic (MCDA) pregnancies. It originates from unbalanced transfer of fluid and vasoactive mediators from one twin to its co-twin via placental anastomoses. This results in hypovolemia in the donor and hypervolemia and vasoconstriction in the recipient twin. Consequently, the recipient demonstrates cardiovascular alterations including atrioventricular valve regurgitation, diastolic dysfunction, and pulmonary stenosis/atresia that do not necessarily correlate with Quintero-stages. Selective fetoscopic laser photocoagulation of placental vascular anastomoses disrupts the underlying pathophysiology and usually improves cardiovascular function in the recipient with normalization of systolic and diastolic function within weeks after treatment. Postnatal studies have demonstrated early decreased arterial distensibility in ex-donor twins, but 10-year follow up is encouraging with survivors showing normal cardiovascular function after TTTS. However, prediction and appropriate early management of TTTS remain poor. Assessment of the cardiovascular system provides additional insight into the pathophysiology and severity of TTTS and may permit more targeted early surveillance of MCDA pregnancies in future. It should form an integral part of the diagnostic algorithm.
authors.affiliation: The Fetal Center, UT Health School of Medicine, Houston, TX, USA.|Department of Obstetrics and Gynecology, Paracelsus Medical University, Salzburg, Austria.
authors.forename: Christoph
authors.identifier: 0000-0002-3184-0980
authors.initials: C
authors.lastname: Wohlmuth
authors.affiliation: The Fetal Center, UT Health School of Medicine, Houston, TX, USA.
authors.forename: Helena M
authors.identifier: 0000-0002-9436-4897
authors.initials: HM
authors.lastname: Gardiner
authors.affiliation: Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Werner
authors.initials: W
authors.lastname: Diehl
authors.affiliation: Department of Obstetrics and Fetal Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Kurt
authors.initials: K
authors.lastname: Hecher
mesh_terms: D003937:Diagnosis, Differential; D005260:Female; D005330:Fetofetal Transfusion / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D011247:Pregnancy; D016216:Ultrasonography, Prenatal
keywords: Cardiovascular physiology; monochorionic twins; multifetal gestation; twin-twin transfusion syndrome