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

Stirnemann, J.; Nasr, B.; Proulx, F.; Essaoui, M.; Ville, Y.

doi:10.1002/uog.7713

Cited by 63 publications

(60 citation statements)

References 20 publications

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“…This approach is perhaps supported in turn by data suggesting that cardiovascular findings are not predictive of outcome after fetoscopic laser therapy for TTTS, although this has not been systematically studied and reports are conflicting. 510,515 Given the body of evidence of cardiovascular manifestations in affected twin pairs, fetal echocardiography should be performed in the diagnostic assessment and initial management of TTTS.…”

Section: Diagnosis and Hemodynamic Assessmentmentioning

confidence: 99%

Diagnosis and Treatment of Fetal Cardiac Disease

Donofrio¹,

Moon-Grady²,

Hornberger³

et al. 2014

Circulation

925

543

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Background— The goal of this statement is to review available literature and to put forth a scientific statement on the current practice of fetal cardiac medicine, including the diagnosis and management of fetal cardiovascular disease. Methods and Results— A writing group appointed by the American Heart Association reviewed the available literature pertaining to topics relevant to fetal cardiac medicine, including the diagnosis of congenital heart disease and arrhythmias, assessment of cardiac function and the cardiovascular system, and available treatment options. The American College of Cardiology/American Heart Association classification of recommendations and level of evidence for practice guidelines were applied to the current practice of fetal cardiac medicine. Recommendations relating to the specifics of fetal diagnosis, including the timing of referral for study, indications for referral, and experience suggested for performance and interpretation of studies, are presented. The components of a fetal echocardiogram are described in detail, including descriptions of the assessment of cardiac anatomy, cardiac function, and rhythm. Complementary modalities for fetal cardiac assessment are reviewed, including the use of advanced ultrasound techniques, fetal magnetic resonance imaging, and fetal magnetocardiography and electrocardiography for rhythm assessment. Models for parental counseling and a discussion of parental stress and depression assessments are reviewed. Available fetal therapies, including medical management for arrhythmias or heart failure and closed or open intervention for diseases affecting the cardiovascular system such as twin–twin transfusion syndrome, lung masses, and vascular tumors, are highlighted. Catheter-based intervention strategies to prevent the progression of disease in utero are also discussed. Recommendations for delivery planning strategies for fetuses with congenital heart disease including models based on classification of disease severity and delivery room treatment will be highlighted. Outcome assessment is reviewed to show the benefit of prenatal diagnosis and management as they affect outcome for babies with congenital heart disease. Conclusions— Fetal cardiac medicine has evolved considerably over the past 2 decades, predominantly in response to advances in imaging technology and innovations in therapies. The diagnosis of cardiac disease in the fetus is mostly made with ultrasound; however, new technologies, including 3- and 4-dimensional echocardiography, magnetic resonance imaging, and fetal electrocardiography and magnetocardiography, are available. Medical and interventional treatments for select diseases and strategies for delivery room care enable stabilization of high-risk fetuses and contribute to improved outcomes. This statement highlights what is currently known and recommended on the basis of evidence and experience in the rapidly advancing and highly specialized field of fetal cardiac care.

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Section: Diagnosis and Hemodynamic Assessmentmentioning

confidence: 99%

Diagnosis and Treatment of Fetal Cardiac Disease

Donofrio¹,

Moon-Grady²,

Hornberger³

et al. 2014

Circulation

925

543

View full text Add to dashboard Cite

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“…Until the precise pathophysiology of this disease process is understood, work such as ours will continue to be somewhat imprecise. Numerous studies have demonstrated an inability to use echocardiography alone as a prognostic tool in pregnancies undergoing treatment for TTTS 18, 27 , likely due to multifactorial influences (both disease-related and procedure-related) on outcomes, and due to lack of recipient cardiomyopathy’s relation to survival of the donor co-twin. However early echocardiography-aided identification of at-risk and affected pregnancies may have clinical utility.…”

Section: Discussionmentioning

confidence: 99%

Diastolic cardiac pathology and clinical twin-twin transfusion syndrome in monochorionic/diamniotic twins

Moon-Grady

Rand

Gallardo

et al. 2011

American Journal of Obstetrics and Gynecology

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Objective to identify differences in echocardiographic profiles of monochorionic/diamniotic pregnancies with early or mild twin-twin transfusion syndrome (TTTS), compared to monochorionic/diamniotic twins affected only by discordant growth or discordant fluid. Study Design retrospective evaluation of sonograms and echocardiograms of twin pregnancies referred for suspected TTTS. Results 112 monochorionic/diamniotic pairs were studied. 41 did not have/develop TTTS, 61 had Stage I/II TTTS. Ten developed TTTS after initially not meeting criteria. TTTS recipients had a higher rate of venous Doppler or tricuspid inflow abnormalities than purported “recipients” in non-TTTS pregnancies (86% vs. 37%, P<0.001). TTTS recipients had shorter tricuspid inflow duration/RR intervals than non-TTTS fetuses (32+/−6% versus 37+/−4%, P<0.001). Logistic regression and recursive partitioning identified shorter tricuspid inflow duration, longer isovolumic relaxation, and ductus venosus abnormality associated with TTTS. Conclusion Diastolic pathology, specifically shorter tricuspid inflow duration, may be considered a hallmark of TTTS distinguishing these pregnancies from other monochorionic/diamniotic twin complications.

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“…4,5 There is controversy over whether these newer scoring systems add any prognostic value to Quintero staging. 6 Selective fetoscopic laser photocoagulation (SFLP) of vascular anastomoses has improved survival and outcomes in TTTS as compared with amnioreduction, but rates of neurological injury and neurodevelopment impairment among survivors remain high. 3,[7][8][9][10][11] Antenatal brain injury in TTTS is thought to be due to alterations in cerebral blood flow, and postnatal brain injury is often due to complications of prematurity.…”

Section: Introductionmentioning

confidence: 99%