Incidence, prognosis, and perinatal outcomes of and risk factors for severe twin–twin transfusion syndrome with right ventricular outflow tract obstruction in the recipient twin after fetoscopic laser photocoagulation

Chang, Yao‐Lung; Chao, An‐Shine; Chang, Shuenn‐Dyh; Cheng, Po‐Jen; Li, Wenfang; Hsu, Chin-Chieh

doi:10.1186/s12884-022-04668-1

Cited by 6 publications

(4 citation statements)

References 35 publications

(46 reference statements)

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“…Doppler sonography in the new donor deteriorated to a highly pathologic flow in the venous system, leading to a caesarean section. These cases show that rigid diagnostic amniotic fluid criteria may underestimate the severity and incidence of TTTS, underscoring the importance of careful surveillance, including arterial and venous Doppler velocimetry, in all monochorionic pregnancies 3 , 13 , 14 .…”

Section: Discussionmentioning

confidence: 85%

Atypical twin-to-twin transfusion syndrome case managed in a single centre in Indonesia with fetoscopic laser photocoagulation and amniopatch: ‘Case Report’

Aldiansyah,

Halim,

Lumbanraja

et al. 2024

Annals of Medicine &Amp; Surgery

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Introduction and importance: The diagnostic criteria for Quintero staging in twin-to-twin transfusion syndrome (TTTS) are not applicable in all cases of TTTS, such as those in which the symptoms overlap with other monochorionic twin complications such as selective intrauterine growth restriction (sIUGR). Case Presentation: A 25-year-old woman, G1P0A0, At 22-24 weeks’ gestational age was diagnosed with TTTS, with no outstanding history of medication use during pregnancy, and no family history of genetic disorder or twin pregnancy. In the donor twin, persistently absent end-diastolic flow in the umbilical artery was observed using Doppler velocimetry. Polyhydramnios was observed in the recipient twins. The fetal weight discordance between the twins was 39%. After two weeks of follow-up, we performed fetoscopic laser photocoagulation and successfully ablated five vascular anastomoses and amnioreduction by 2.5 liters. Five days after the laser surgery, the patient developed amniotic fluid leakage, and an amniopatch was performed. We did the caesarean section at 34 weeks because of severe preeclampsia, the donor and recipient birth weights were 1,120 g and 1,837 g, respectively (weight discordance 39%). The APGAR scores were 3/4 and 6/8, respectively. The donor twin died six days after delivery due to respiratory failure, and the recipient twin survived. Neonatal echocardiography of the surviving twin showed no tricuspid regurgitation. No long-term follow-up was performed. Clinical discussion: The traditional diagnostic criteria for TTTS stage 3 were not met and overlapped with the diagnostic criteria for sIUGR type 2. This is the first procedure reported in Indonesia for Atypical TTTS with the outcome, one twin survived. Conclusion: Some TTTS cases do not meet traditional diagnostic criteria and overlap with other monochorionic twin complications.

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Section: Discussionmentioning

confidence: 85%

Atypical twin-to-twin transfusion syndrome case managed in a single centre in Indonesia with fetoscopic laser photocoagulation and amniopatch: ‘Case Report’

Aldiansyah,

Halim,

Lumbanraja

et al. 2024

Annals of Medicine &Amp; Surgery

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“…Ant Ant Fallot and are seen in 6-13% of recipient twins in cases of twin-to-twin transfusion syndrome 25 . In valvular anomalies, it is necessary to differentiate fused and non-dysplastic valves (the most frequent type) from non-fused and dysplastic valves, which can be found in RASopathies, such as Noonan syndrome (estimated incidence of Noonan syndrome, 1 in 1000-2500 live births) and cardiofaciocutaneous and related syndromes 26,27 .…”

Section: Antmentioning

confidence: 99%

“…PS encompasses a spectrum of anomalies, which should be differentiated, according to the affected valve region, into subvalvular, valvular and supravalvular anomalies. Subvalvular anomalies are frequently found in tetralogy of Fallot and are seen in 6–13% of recipient twins in cases of twin‐to‐twin transfusion syndrome 25 . In valvular anomalies, it is necessary to differentiate fused and non‐dysplastic valves (the most frequent type) from non‐fused and dysplastic valves, which can be found in RASopathies, such as Noonan syndrome (estimated incidence of Noonan syndrome, 1 in 1000–2500 live births) and cardiofaciocutaneous and related syndromes 26,27 .…”

Section: Screening and Diagnosis Of Pulmonary Artery Abnormalitiesmentioning

confidence: 99%

Prenatal screening and diagnosis of pulmonary artery anomalies

Lesieur

Zaffran

Chaoui³

et al. 2023

Ultrasound in Obstet & Gyne

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Congenital pulmonary artery anomalies are rare. Their antenatal diagnosis requires good knowledge of fetal cardiac anatomy because their clinical presentation varies depending on the type and severity of the underlying lesion. Screening of these vascular anomalies can be straightforward in some cases because of significant associated consequences that are detected easily on ultrasound, while other anomalies have considerably less obvious features. There may be an associated genetic syndrome. The aim of this review was to define anomalies of the main pulmonary artery and its branches and to propose, through the identification of suspicious findings during routine antenatal heart examination, an optimal screening method for the pulmonary artery pathway. We propose that pulmonary artery anomalies can be classified antenatally into four types of disorder. Herein we describe 14 cases subgrouped accordingly as: anomalies of the pulmonary valvular region, with stenosis or atresia of the valve (n = 4); conotruncal abnormalities (n = 4); anomalies associated with abnormal origin or course of the pulmonary artery (n = 4); and anomalies associated with abnormal growth of the pulmonary artery and its branches (n = 2). We highlight the need to differentiate the three-vessel view from the three-vessel-and-trachea view when assessing a fetus with a congenital pulmonary artery anomaly.

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“…The true prevalence might be underestimated, as CHDs leading to death are not included. A limitation is the biased CHD representation in the literature, with some studies focusing solely on RVOTO presence, 65,[97][98][99] while others with a broader scope lack detailed findings for the TTTS subgroup. 100,101 Two studies exclusively reported on RVOTO but included a consecutive cohort, 44,82 raising uncertainty about the inclusion of various CHD types potentially delivered elsewhere.…”

Section: Chdsmentioning

confidence: 99%

Cardiac adaptation and malformation in twin–twin transfusion syndrome and selective fetal growth restriction: A systematic review

Noll,

Gijtenbeek,

Verweij

et al. 2024

Prenatal Diagnosis

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ObjectivesThis systematic review explores cardiac adaptation in monochorionic (MC) twins with twin–twin transfusion syndrome (TTTS) or selective fetal growth restriction (sFGR) and assesses the risk of congenital heart defects (CHDs).MethodsAdhering to PRISMA guidelines, 63 studies were reviewed (49 on cardiac adaptation, 13 on CHD, one on both). A narrative synthesis of cardiac adaptation patterns was performed. Additionally, a meta‐analysis compared the livebirth prevalence of CHD in TTTS and sFGR against uncomplicated MC twins.ResultsIn TTTS recipients, cardiac function may be impaired for diastolic, systolic, as well as global functions, while in donors, cardiac function is generally preserved. In sFGR, large twins may show hypertrophic cardiomyopathy, and small twins may show impaired systolic function. Co‐occurrence of TTTS and sFGR magnifies cardiac impact but is often underreported. Meta‐analysis for CHD prevalence revealed a relative risk ratio of 3.5 (95% CI: 2.5–4.9) for TTTS and 2.2 (95%CI: 1.3–3.5) for sFGR compared with uncomplicated MC twins.ConclusionsThis study highlights the well‐documented cardiac adaptation in TTTS, contrasting with limited understanding in sFGR. Elevated CHD risks were observed in both conditions. Enhanced cardiovascular surveillance is warranted in complicated MC twin pregnancies. Future research should explore cardiac adaptation in sFGR and its long‐term consequences.

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Incidence, prognosis, and perinatal outcomes of and risk factors for severe twin–twin transfusion syndrome with right ventricular outflow tract obstruction in the recipient twin after fetoscopic laser photocoagulation

Cited by 6 publications

References 35 publications

Atypical twin-to-twin transfusion syndrome case managed in a single centre in Indonesia with fetoscopic laser photocoagulation and amniopatch: ‘Case Report’

Atypical twin-to-twin transfusion syndrome case managed in a single centre in Indonesia with fetoscopic laser photocoagulation and amniopatch: ‘Case Report’

Prenatal screening and diagnosis of pulmonary artery anomalies

Cardiac adaptation and malformation in twin–twin transfusion syndrome and selective fetal growth restriction: A systematic review

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