Fetal origins of reduced arterial distensibility in the donor twin in twin-twin transfusion syndrome

Cheung, Yiu‐fai; Taylor, M. J. O.; Fisk, Nicholas M.; Redington, Andrew N.; Gardiner, Helena M.

doi:10.1016/s0140-6736(00)02068-7

Cited by 114 publications

(88 citation statements)

References 4 publications

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“…In the pilot study, 10 only half of the TTTS pregnancies recruited had an AAA, thus reducing the effects of this confounder, and we showed that those without an AAA tended to have greater PWV discordance (donor PWV greater than recipient). Second, the chronicity and degree of volume loading is widely variable, and the potential programming effect of this process at differing gestations uncertain.…”

Section: Gardiner Et Al Laser Therapy In Ttts and Vascular Programminmentioning

confidence: 70%

“…PWV is relatively easy to measure and is reproducible in small children, 10 but examination of the muscular brachial artery may not be ideal because its compliance depends on vascular smooth muscle activity as well as its structure and material properties. This may be one explanation for the lack of differences observed in blood pressure between the groups because systolic blood pressure, although related to aortic compliance, is unlikely to be strongly related to brachial artery elasticity as measured in this study.…”

Section: Discussionmentioning

confidence: 99%

“…Data on a proportion of the nonlaser patients and control subjects have previously been reported in preliminary form. 10 Statistical calculations were performed with Stata 6.0 software (Statistics Data Analysis).…”

Section: Methodsmentioning

confidence: 99%

“…10 We hypothesize that increased donor PWV values are a consequence of chronic hypovolemia resulting from unbalanced intertwin transfusion, which might be reversed or prevented by definitive treatment. We investigated this hypothesis by examining PWV in twin survivors of TTTS treated by laser, which, by abolishing or restricting intertwin transfusion at an early stage, might be expected to reverse or prevent vascular remodeling in utero.…”

mentioning

confidence: 99%

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Twin-Twin Transfusion Syndrome

et al. 2003

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Background-In twin-twin transfusion syndrome (TTTS), the donor and recipient fetus are exposed to differing volume loads and show discordant intertwin vascular compliance in childhood despite identical genotype. We hypothesized that discordance is prevented by intrauterine endoscopic laser ablation of placental anastomoses, which abolishes intertwin transfusion. We tested this by examining pulse wave velocity (PWV) in brachial arteries of twin survivors of TTTS treated with and without laser therapy. Methods and Results-One hundred children (50 twin pairs, 27 with TTTS) were studied. Group 1 comprised 14 monochorionic (MC) twin pairs with TTTS treated symptomatically; group 2 comprised 13 MC twin pairs with TTTS treated by laser. The control groups comprised 12 MC twin pairs without TTTS (group 3) and 11 dichorionic twin pairs (group 4). Fetal cardiovascular data, predictive factors for, and duration of TTTS and cord blood were collected prospectively. We measured blood pressure and PWV photoplethysmographically at a median corrected postnatal age of 11 months (range, 1 week to 66 months). Both TTTS groups showed marked intertwin PWV discordance, unlike MCDA control subjects. The PWV discordance seen in laser treated twin pairs resembled that of dichorionic control subjects (heavier individual with higher PWV), whereas group 1 showed the opposite (negative) intertwin discordance (ANOVA F (1,45)ϭ4.5, Pϭ0.04). No significant differences in blood pressure or intrauterine growth were observed between TTTS groups. Conclusions-Vascular programming is evident in monozygotic twins with intertwin transfusion and is altered but not abolished by intrauterine therapy to resemble that seen in dichorionic twins.

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Section: Gardiner Et Al Laser Therapy In Ttts and Vascular Programminmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

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Twin-Twin Transfusion Syndrome

et al. 2003

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“…At 10 years of age, Halvorsen et al 33 report, in a cohort of 11 twin pairs, no differences in BPs, heart rate, structure or systolic ventricular function between twins but a significantly reduced early diastolic function in the recipients. Conduit arteries stiffness, evaluated through brachioradial pulse wave velocity, was found increased in the donors in two studies realized around 9 to 11 months of age, 34,35 the lower arterial distensibility was attributed by the investigators to intrauterine growth restriction 36,37 and vascular adaptation to chronic hypovolemia in utero. 38 Overall the neonatal outcomes of this cohort of TTTS twins are comparable to other published studies.…”

Section: Discussionmentioning

confidence: 94%

Blood pressures in newborns with twin–twin transfusion syndrome

Mercanti

Boivin

et al. 2011

J Perinatol

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Objective: In addition to unbalanced flow through placental anastomoses, evidence suggests that transfer of circulating vasoactive elements from the donor to the recipient contribute to the pathological process of twin-twin transfusion syndrome (TTTS). The objective of this study was to test the hypothesis that TTTS recipients have higher blood pressure (BP) at birth than donors.Study Design: Chart review of all TTTS infants born from 1996 to 2007 with both twins alive X24 h (51 pairs; average gestational age 30 ± 3 weeks).Results: Both systolic and diastolic neonatal BPs were significantly higher in recipients. When expressed relative to predicted BP for birth weight (BW), BP were lower than expected in donors and higher in recipients.Conclusions: Data indicate that TTTS recipients have BP significantly higher than donors and than BP expected for BW. The long-term impact of these early hemodynamic perturbations remains to be determined.

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Fetal origins of reduced arterial distensibility in the donor twin in twin-twin transfusion syndrome

Cited by 114 publications

References 4 publications

Twin-Twin Transfusion Syndrome

Twin-Twin Transfusion Syndrome

Blood pressures in newborns with twin–twin transfusion syndrome

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