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P21.05: Acute Increases in Fetal Cardiac Output Following Selective Fetoscopic Laser Procedure in Twin‐to‐twin Transfusion Syndrome is Associated with Improved Right Ventricular Systolic Function

Ultrasound in Obstetrics &amp Gynecology(2011)

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Abstract
To compare estimated combined cardiac output (CCO) and its determinants in fetuses with twin-to-twin transfusion syndrome (TTTS) before and after selective fetoscopic laser procedure (SFLP). Retrospective review of 22 patients with TTTS who underwent a comprehensive fetal echocardiography pre- and post-SFLP. Fetal echocardiograms were performed on both donor and recipient twins prior to (mean 1.6 ± 0.9 days) and following (mean 4.3 ± 2.2 days) SFLP. Right and left ventricular shortening fraction, heart rate and CCO (indexed to estimated fetal weight) were obtained in each fetus by two-dimensional and Doppler fetal echocardiography. Comparisons between donor and recipient twins and between pre- and post-SFLP studies were performed by t-test; P-values < 0.05 were assigned statistical significance. CCO in both donor and recipient twins was equivalent prior to SFLP. Post-SFLP, both sets of fetuses demonstrated an increase in CCO, although this did not reach significance in donor twins (donor P = 0.1, recipient P = 0.01, Figure). Both twins demonstrated an increase in right ventricular shortening fraction (donor P = 0.04, recipient P = 0.03) without a change in heart rate. CCO is comparable in both donor and recipient twins prior to SFLP. SFLP is associated with an increase in CCO in recipient, and possibly donor, twins. An acute improvement in right ventricular systolic function may account for the observed increase in CCO following SFLP. Supporting information can be found in the online version of this abstract. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
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Key words
Fetoscopic Laser Coagulation,Twin Pregnancy,Fetal DNA Analysis,Selective Embryo Transfer,Trisomy Detection
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