Dual twin survival after laser surgery for twin–twin transfusion syndrome

Objective Twin survivors of twin-twin transfusion syndrome may be at risk for early onset of cardiovascular disease. The aim of this study was to determine prevalence and risk factors for elevated blood pressure among children treated with selective laser photocoagulation of the communicating vessels. Study Design Data were prospectively collected from surviving children treated for twin-twin transfusion syndrome with laser surgery between 2008 and 2010. Systolic and diastolic blood pressures were obtained from 91 child survivors at age 24 months (±6 weeks) and evaluated based on age, sex, and height percentile. Blood pressure percentiles were calculated for each patient and categorized as normal (<95%) or abnormal (>95%). Clinical variables were evaluated using multilevel regression models to evaluate risk factors for elevated blood pressure. Results Blood pressure was categorized as normal in 38%%, and abnormal in 62% of twin survivors based on percentile for sex, age and height; a comparable distribution was found for diastolic blood pressure elevation. There were no differences between donor and recipient twins for absolute systolic and diastolic blood pressure or blood pressure classification. In a multivariate analysis, significant risk factors for higher systolic blood pressure included prematurity (β=−0.54, 95% Confidence Interval [−0.99, −0.09]; p=0.02), higher weight percentile (β=0.24, 95% Confidence Interval [0.05, 0.42]; p=0.01), and presence of cardiac disease (β=0.50, 95% Confidence Interval [0.10, 0.89]; p=0.01). Prematurity was also a significant risk for abnormal diastolic blood pressure (Odds Ratio=0.89, 95% Confidence Interval [0.80, 1.00], p=0.05). Conclusions Child survivors of twin-twin transfusion syndrome had elevated systolic and diastolic blood pressure measurements at 2 years of age, with no differences seen between former donor and recipient twins. Prematurity may be a risk factor for elevated blood pressure measurements in this population. Future studies are warranted to ascertain whether these cardiovascular findings persist over time.

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“…Cases were treated exclusively by SLPCV with or without sequential technique, as described in detail previously. 12, 13 …”

Section: Methodsmentioning

confidence: 99%

“…9–11 As survival rates for TTTS treated with fetal laser surgery have continued to improve, the focus is shifting towards evaluation of long-term risks in this population. 12, 13 …”

Section: Introductionmentioning

confidence: 99%

Blood pressure evaluation in children treated with laser surgery for twin-twin transfusion syndrome at 2-year follow-up

Pruetz

Schrager

Wang

et al. 2015

American Journal of Obstetrics and Gynecology

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“…New evidence suggests that early Doppler findings of decreased right ventricular diastolic filling time with monophasic tricuspid valve inflow Doppler may predict progression of TTTS, leading to earlier diagnosis and intervention [45,46]. The current preferred fetal therapy is selective laser coagulation of the communicating vessels that effectively separates the twin placental circulations and normalizes the blood volume in both twins, resulting in improved perinatal survival and improved neurologic outcomes [47,48].…”

Section: Twinetwin Transfusion Syndromementioning

confidence: 98%