Cardiac outcomes of hydrops as a result of twin-twin transfusion syndrome treated with laser surgery

• Published in: Journal of paediatrics and child health 2009-01, Vol.45 (1-2), p.48-52
• Main Authors: Gray, Peter H, Ward, Cameron, Chan, Fung-Yee
• Format: Article
• Language: English
• Subjects: Arteriovenous Anastomosis - surgery; Cardiac Output; Cardiovascular system; Clinical outcomes; Female; Fetal Heart - diagnostic imaging; Fetal Heart - pathology; Fetal Heart - physiopathology; Fetal Heart - surgery; Fetofetal Transfusion - complications; Fetofetal Transfusion - physiopathology; Fetofetal Transfusion - surgery; Fetuses; heart; Heart Defects, Congenital - etiology; Heart Defects, Congenital - prevention & control; Humans; hydrops; Hydrops Fetalis - diagnostic imaging; Hydrops Fetalis - etiology; Hydrops Fetalis - surgery; Laser surgery; Laser Therapy; Medical disorders; Pregnancy; Prenatal care; Treatment Outcome; twin-twin transfusion syndrome; Twins; Ultrasonography, Prenatal
• ISSN: 1034-4810; 1440-1754
• DOI: 10.1111/j.1440-1754.2008.01425.x

Aim:  To determine cardiac outcomes of foetal hydrops as a result of twin–twin transfusion syndrome treated with laser surgery. Methods:  Hydrops identified in 16 recipient foetuses with twin–twin transfusion syndrome was treated with laser ablation surgery to anastomotic vessels. Prior to laser surgery, the foetuses were assessed by echocardiography for cardiac abnormalities and ventricular and valvular dysfunction. After delivery, echocardiography was performed on 15 of the 16 newborn infants. Results:  Foetal echocardiography indicated impaired biventricular function in the 16 hydropic foetuses. Five foetuses had little or no forward flow through the pulmonary valve, while four had pulmonary regurgitation. Following laser surgery performed at a mean of 22.9 weeks gestation, hydrops resolved in all cases. Delivery occurred at a mean of 33.6 weeks gestation. Post‐natal echocardiography revealed cardiac abnormalities in five neonates, of whom three had right ventricular outflow tract obstruction. One preterm infant with severe pulmonary stenosis died with intractable cardiac failure. Conclusion:  The majority of hydropic infants with twin–win transfusion syndrome have normal cardiac outcomes following intrauterine laser surgery. As up to one‐third may have cardiac abnormalities, cardiological monitoring is recommended during the first year of life.