open access

Vol 90, No 4 (2019)
ORIGINAL PAPERS Obstetrics
Published online: 2019-04-29
Get Citation

Assessment of cardiac function in donor and recipient fetuses during a 7-day follow-up after selective laser photocoagulation of communicating vessels due to TTTS

Katarzyna Leszczynska, Jaroslaw Meyer-Szary, Maciej Chojnicki, Ireneusz Haponiuk, Krzysztof Preis, Katarzyna Stefanska, Katarzyna Gierat-Haponiuk, Malgorzata Swiatkowska-Freund
DOI: 10.5603/GP.2019.0034
·
Pubmed: 31059111
·
Ginekol Pol 2019;90(4):189-194.

open access

Vol 90, No 4 (2019)
ORIGINAL PAPERS Obstetrics
Published online: 2019-04-29

Abstract

Objectives: The aim of the study was to analyze the changes in cardiac function and myocardial contractility of donor and recipient fetuses with twin-to-twin transfusion syndrome (TTTS) subjected to selective laser photocoagulation of the communicating vessels (SLPCV), between and after the procedure. Finally, we verified if fetuses with Quintero’s stage I TTTS presented with early impairment of myocardial contractility. 

Material and methods: We selected 77 consecutive women with twin pregnancies, whose both fetuses survived at least seven days post-SLPCV. Myocardial contractility of both fetuses was evaluated ultrasonographically, and their myocardial performance indices (Tei-Index values) and shortening fractions (SF) were determined. 

Results: In donor fetuses, the Tei-Index values for both right and left ventricle remained within the respective reference ranges both before the procedure and during a 7-day follow-up. A significant change in shortening fraction values for the left ventricle in recipient fetuses and the right ventricle of in the donors was observed during a 7-day follow-up. 

Conclusions: Comparison of the cardiac parameters of donors and recipients revealed significant differences in Tei-indices during the entire follow-up period. 

The group with Quintero’s I stage TTTS included 74% of recipient fetuses with abnormal Tei-Index values for the right ventricle (mean 0.53). 

Abstract

Objectives: The aim of the study was to analyze the changes in cardiac function and myocardial contractility of donor and recipient fetuses with twin-to-twin transfusion syndrome (TTTS) subjected to selective laser photocoagulation of the communicating vessels (SLPCV), between and after the procedure. Finally, we verified if fetuses with Quintero’s stage I TTTS presented with early impairment of myocardial contractility. 

Material and methods: We selected 77 consecutive women with twin pregnancies, whose both fetuses survived at least seven days post-SLPCV. Myocardial contractility of both fetuses was evaluated ultrasonographically, and their myocardial performance indices (Tei-Index values) and shortening fractions (SF) were determined. 

Results: In donor fetuses, the Tei-Index values for both right and left ventricle remained within the respective reference ranges both before the procedure and during a 7-day follow-up. A significant change in shortening fraction values for the left ventricle in recipient fetuses and the right ventricle of in the donors was observed during a 7-day follow-up. 

Conclusions: Comparison of the cardiac parameters of donors and recipients revealed significant differences in Tei-indices during the entire follow-up period. 

The group with Quintero’s I stage TTTS included 74% of recipient fetuses with abnormal Tei-Index values for the right ventricle (mean 0.53). 

Get Citation

Keywords

SLPCV; donor; recipient; heart assessment; laser photocoagulation; Tei-Index

About this article
Title

Assessment of cardiac function in donor and recipient fetuses during a 7-day follow-up after selective laser photocoagulation of communicating vessels due to TTTS

Journal

Ginekologia Polska

Issue

Vol 90, No 4 (2019)

Pages

189-194

Published online

2019-04-29

DOI

10.5603/GP.2019.0034

Pubmed

31059111

Bibliographic record

Ginekol Pol 2019;90(4):189-194.

Keywords

SLPCV
donor
recipient
heart assessment
laser photocoagulation
Tei-Index

Authors

Katarzyna Leszczynska
Jaroslaw Meyer-Szary
Maciej Chojnicki
Ireneusz Haponiuk
Krzysztof Preis
Katarzyna Stefanska
Katarzyna Gierat-Haponiuk
Malgorzata Swiatkowska-Freund

References (22)
  1. Victor YH. Risk in multiple births especially from twin-to-twin transfusion syndrome. Circulation. 2002; 106: 585–591.
  2. Herberg U, Gross W, Bartmann P, et al. Long term cardiac follow up of severe twin to twin transfusion syndrome after intrauterine laser coagulation. Heart. 2006; 92(1): 95–100.
  3. Quintero RA, Dickinson JE, Morales WJ, et al. Stage-based treatment of twin-twin transfusion syndrome. Am J Obstet Gynecol. 2003; 188(5): 1333–1340.
  4. Diagnosis and Staging of Twin to Twin Transfusion Syndrome. www.perinatology.com.
  5. Davey BT, Donofrio MT, Moon-Grady AJ, et al. Development and validation of a fetal cardiovascular disease severity scale. Pediatr Cardiol. 2014; 35(7): 1174–1180.
  6. Shah AD, Border WL, Crombleholme TM, et al. Initial fetal cardiovascular profile score predicts recipient twin outcome in twin-twin transfusion syndrome. J Am Soc Echocardiogr. 2008; 21(10): 1105–1108.
  7. Habli M, Michelfelder E, Cnota J, et al. Prevalence and progression of recipient-twin cardiomyopathy in early-stage twin-twin transfusion syndrome. Ultrasound Obstet Gynecol. 2012; 39(1): 63–68.
  8. Stirnemann JJ, Nasr B, Proulx F, et al. Evaluation of the CHOP cardiovascular score as a prognostic predictor of outcome in twin-twin transfusion syndrome after laser coagulation of placental vessels in a prospective cohort. Ultrasound Obstet Gynecol. 2010; 36(1): 52–57.
  9. Quintero RA, Ishii K, Chmait RH, et al. Sequential selective laser photocoagulation of communicating vessels in twin-twin transfusion syndrome. J Matern Fetal Neonatal Med. 2007; 20(10): 763–768.
  10. Habli M, Michelfelder E, Livingston J, et al. Acute effects of selective fetoscopic laser photocoagulation on recipient cardiac function in twin-twin transfusion syndrome. Am J Obstet Gynecol. 2008; 199(4): 412.e1–412.e6.
  11. Papanna R, Mann LK, Molina S, et al. Changes in the recipient fetal Tei index in the peri-operative period after laser photocoagulation of placental anastomoses for twin-twin transfusion syndrome. Prenat Diagn. 2011; 31(2): 176–180.
  12. Quintero R. (ed). Twin-twin transfusion syndrome. Informa Health, London 2007.
  13. Respondek-Liberska M, Janiak K. Protokół badania kardiologicznego u płodu w ośrodku referencyjnym. Pol Przegl Kardiolo. 2010; 12(3): 212–218.
  14. Falkensammer CB, Paul J, Huhta JC. Fetal congestive heart failure: correlation of Tei-index and Cardiovascular-score. J Perinat Med. 2001; 29(5): 390–398.
  15. Preis K, Leszczyńska K, Świątkowska-Freund M, et al. Kurczliwość komór serca płodów po zabiegu laserowej okluzji naczyń łączących w TTTS. Perinatologia, Neonatologia i Ginekologia. 2009; 2(1): 48–49.
  16. Leszczyńska K, Preis K, Swiatkowska-Freund M, et al. Comparison of fetal myocardial contractility before and after laser photocoagulation of communicating vessels in twin-to-twin transfusion syndrome. Ginekol Pol. 2014; 85(4): 283–286.
  17. Stirnemann JJ, Mougeot M, Proulx F, et al. Profiling fetal cardiac function in twin-twin transfusion syndrome. Ultrasound Obstet Gynecol. 2010; 35(1): 19–27.
  18. Leszczyńska K, Preis K, Respondek-Liberska M, et al. Recommendations for Fetal Echocardiography in Twin Pregnancy in 2016. Prenatal Cardiology. 2016; 6(1): 6–15.
  19. Washburn EE, Sparks TN, Gosnell KA, et al. Stage I Twin-Twin Transfusion Syndrome: Outcomes of Expectant Management and Prognostic Features. Am J Perinatol. 2018; 35(14): 1352–1357.
  20. Perry H, Duffy JMN, Umadia O, et al. International Collaboration to Harmonise Outcomes for Twin-Twin Transfusion Syndrome (CHOOSE). Outcome reporting across randomized trials and observational studies evaluating treatments for twin-twin transfusion syndrome: systematic review. Ultrasound Obstet Gynecol. 2018; 52(5): 577–585.
  21. Haponiuk I, Chojnicki M, Szofer-Sendrowska A, et al. "Planned" permanent pacemaker implantation in one-day-old newborn after prenatal diagnosis of congenital complete atrioventricular heart block. Kardiochir Torakochirurgia Pol. 2014; 11(1): 76–78.
  22. Kornacka M, Respondek-Liberska M. The place for neonatologist in proper perinatal care. Prenatal Cardiology. 2013; 3(3): 12–15.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

By "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk
tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail:  viamedica@viamedica.pl