title: Rate and Outcomes of Pulmonary Stenosis and Functional Pulmonary Atresia in Recipient Twins with Twin-Twin Transfusion Syndrome.
abstract: OBJECTIVE
  To evaluate the rate of pulmonary stenosis and functional pulmonary atresia (PS/PA) in recipient twins prior to fetal surgery for twin-twin transfusion syndrome (TTTS) and their pre- and postnatal outcomes.
  
  
  METHODS
  We carried out a prospective study including 260 cases of TTTS. Echocardiography was performed before laser surgery to detect the presence of PS/PA. The outcomes of recipients with and without PS/PA were compared. The need of postnatal cardiac interventions and the survival rate at 6 months of age were also evaluated.
  
  
  RESULTS
  PS was observed in 16/260 (6.2%) of recipient twins and PA in 12/260 (4.6%). After fetal surgery, 10/28 (35.7%) recipients died, 9/28 (32.1%) showed in utero regression, and 9/28 (32.1%) had persistence of PS/PA. Postnatally, seven recipients underwent percutaneous balloon pulmonary valvuloplasty, one required surgical valvotomy and one palliative surgery. Pregnancies with recipient twins with PS/PA had lower survival of at least one twin (67.9 vs. 83.6%, p = 0.045) and lower overall survival (57.1 vs. 72.8%, p = 0.015) at 6 months of age.
  
  
  CONCLUSIONS
  PS and PA were observed in 10.8% of recipients. Among these, about one third showed persistence of pulmonary valve pathology after delivery, which stresses the need for strict follow-up.
authors.affiliation: BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), IDIBAPS, University of Barcelona, Barcelona, Spain.
authors.forename: Javier U
authors.initials: JU
authors.lastname: Ortiz
authors.forename: Narcís
authors.initials: N
authors.lastname: Masoller
authors.forename: Olga
authors.initials: O
authors.lastname: Gómez
authors.forename: Mar
authors.initials: M
authors.lastname: Bennasar
authors.forename: Elisenda
authors.initials: E
authors.lastname: Eixarch
authors.forename: Silvia M
authors.initials: SM
authors.lastname: Lobmaier
authors.forename: Fàtima
authors.initials: F
authors.lastname: Crispi
authors.forename: Eduard
authors.initials: E
authors.lastname: Gratacos
authors.forename: Josep María
authors.initials: JM
authors.lastname: Martinez
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D005330:Fetofetal Transfusion / Q000000981:diagnostic imaging* / Q000401:mortality*; D005500:Follow-Up Studies; D006801:Humans; D011247:Pregnancy; D011446:Prospective Studies; D018633:Pulmonary Atresia / Q000000981:diagnostic imaging* / Q000401:mortality*; D011666:Pulmonary Valve Stenosis / Q000000981:diagnostic imaging* / Q000401:mortality*; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome
keywords: Laser surgery; Pulmonary atresia; Pulmonary stenosis; Recipient twin; Twin-twin transfusion syndrome