Abstract 17384: Increased Estimated Cardiac Output and Functional Improvement in Fetuses in Response to Laser Therapy for Twin-Twin Transfusion Syndrome
BACKGROUND: Twin-twin transfusion syndrome (TTTS) is thought to involve placental vascular anastomoses that cause a hyperdynamic state in the donor fetus and volume overload in the recipient fetus.
OBJECTIVES: We aim to determine the relationship between estimated combined cardiac output (CCO) obtained on fetal echocardiography in fetuses with TTTS and response to laser therapy.
METHODS: We performed a retrospective review of fetuses with TTTS who received echocardiograms prior and after laser therapy. We divided fetuses into donor and recipient fetuses, and compared hemodynamic parameters including CCO and right and left ventricular myocardial performance indices (LVMPI and RVMPI). Those with fetal demise during or soon after the procedure who could not receive a post-laser echocardiogram were included in the study, but excluded from pre-post analysis. Perinatal mortality was defined as intrauterine fetal demise or neonatal mortality.
RESULTS: Pre and post-Laser therapy echocardiograms were performed in 20 mothers (40 fetuses). Donor CCO increased from a mean of 490 ± 130 ml/min/kg pre-Laser to 612 ± 134 ml/min/kg post-Laser (p=0.029). There was no significant change in mean recipient CCO from pre-laser 555 ± 164 ml/min/kg to post-laser 576 ± 122 ml/min/kg (p=0.664). Average RVMPI and LVMPI decreased from pre-laser to post-laser in both donor and recipient fetuses (donor RVMPI 0.41 ± 0.14 to 0.32 ± 0.06, p=0.02; donor LVMPI 0.36 ± 0.13 to 0.25 ± 0.06, p=0.01; recipient RVMPI 0.62 ± 0.13 to 0.44 ± 0.14, p<0.01; recipient LVMPI 0.55 ± 0.13 to 0.39 ± 0.14, p<0.01). Four fetuses (all donor) suffered intrauterine demise before post-laser echocardiograms could be performed. Overall, 12 (4 donor, 8 recipient) fetuses experienced a drop in CCO in response to laser therapy. Of these, 2 (17%) fetuses (1 donor and 1 recipient) experienced perinatal mortality, compared with 0 fetuses who had experienced an increase in CCO (p=0.22)
CONCLUSIONS: Laser therapy results in improved RVMPI and LVMPI in both donor and recipient fetuses. Donor fetuses are at particular risk during laser therapy. Donor fetuses appear to experience an immediate increase in CCO in response to laser therapy. Those who experience a drop in CCO may be at increased risk for intrauterine demise.
- © 2013 by American Heart Association, Inc.