title: Estimated combined cardiac output and laser therapy for twin-twin transfusion syndrome.
abstract: BACKGROUND
  Twin-twin transfusion syndrome (TTTS) is the major cause for fetal demise in monochorionic diamniotic pregnancies. Estimated combined cardiac output (CCO) has not been studied in this setting. The primary aims of this study were to compare CCO in twin donor and recipient fetuses and assess differences in CCO before and after laser coagulation therapy. A secondary aim was to evaluate the relationship of CCO with perinatal mortality, defined as intrauterine or neonatal mortality (≤30 days of age) in fetuses that underwent laser coagulation therapy.
  
  
  METHODS
  We performed a retrospective review of fetuses with TTTS who received echocardiograms prior to laser therapy. Prelaser echocardiograms were performed in 66 fetuses, of which 45 (21 donor and 24 recipient) survived to the postlaser echocardiogram.
  
  
  RESULTS
  Donor CCO increased from a mean of 487±137 mL/min/kg prelaser to 592±128 mL/min/kg postlaser (P=.025). There was no significant change in mean recipient CCO from prelaser 551±165 mL/min/kg to postlaser 575±112 mL/min/kg (P=.564). In recipient fetuses, higher prelaser CCO correlated with increasing Quintero stage (P=.010) and perinatal mortality (P=.003). Thirty-day postnatal outcome data were available for 38 fetuses, of whom 34 (89%) survived. Amongst survivors, 25 (74%) experienced an increase in CCO, while 9 (26%) experienced a decrease in CCO (P=.010). Donor fetuses had higher CCO after laser therapy.
  
  
  CONCLUSIONS
  Higher prelaser CCO in recipient fetuses may indicate more advanced disease. Fetuses who exhibit a decrease in CCO after therapy laser may be at higher risk for perinatal mortality.
authors.affiliation: Texas Children's Fetal Center, Texas Children's Hospital, Houston, Texas. shirazmaskatia@gmail.com.|Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas. shirazmaskatia@gmail.com.
authors.forename: Shiraz A
authors.initials: SA
authors.lastname: Maskatia
authors.affiliation: Texas Children's Fetal Center, Texas Children's Hospital, Houston, Texas.|Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
authors.forename: Rodrigo
authors.initials: R
authors.lastname: Ruano
authors.affiliation: Texas Children's Fetal Center, Texas Children's Hospital, Houston, Texas.|Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
authors.forename: Alireza A
authors.initials: AA
authors.lastname: Shamshirsaz
authors.affiliation: Texas Children's Fetal Center, Texas Children's Hospital, Houston, Texas.|Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
authors.forename: Pouya
authors.initials: P
authors.lastname: Javadian
authors.affiliation: Texas Children's Fetal Center, Texas Children's Hospital, Houston, Texas.|Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
authors.forename: Joshua A
authors.initials: JA
authors.lastname: Kailin
authors.affiliation: Texas Children's Fetal Center, Texas Children's Hospital, Houston, Texas.|Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Belfort
authors.affiliation: Texas Children's Fetal Center, Texas Children's Hospital, Houston, Texas.|Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
authors.forename: Carolyn A
authors.initials: CA
authors.lastname: Altman
authors.affiliation: Texas Children's Fetal Center, Texas Children's Hospital, Houston, Texas.|Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas.
authors.forename: Nancy A
authors.initials: NA
authors.lastname: Ayres
mesh_terms: D002302:Cardiac Output; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005330:Fetofetal Transfusion / Q000000981:diagnostic imaging* / Q000401:mortality / Q000628:therapy*; D006801:Humans; D017075:Laser Coagulation / Q000401:mortality*; D054238:Perinatal Mortality; D011183:Postoperative Complications / Q000401:mortality* / Q000517:prevention & control; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013781:Texas / Q000453:epidemiology; D016896:Treatment Outcome; D014427:Twins / Q000706:statistics & numerical data
keywords: estimated cardiac output; fetal echocardiography; fetal intervention; twin gestation; twin-twin transfusion syndrome