Long-term morbidity after fetal endoscopic surgery for severe twin-to-twin transfusion syndrome

Kowitt, Benjamin; Tucker, Richard; Watson-Smith, Debra; Muratore, Christopher S.; O’Brien, Barbara; Vohr, Betty R.; Carr, Stephen R.; Luks, François I.

doi:10.1016/j.jpedsurg.2011.10.021

Cited by 18 publications

(14 citation statements)

References 30 publications

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“…The most severely affected cases were delivered before 28 weeks' gestational age. This is consistent with a recent study published by Kowitt et al in 2012 who found the degree of prematurity at birth to be the best predictor of temporary or permanent sequelae following fetoscopic laser ablation for TTTS [37]. Although a correlation between increasing Quintero stage and adverse neurodevelopmental outcome has been suggested in one recent study, we did not find any independent effect on medium-term neurodevelopmental outcome [38].…”

Section: Commentsupporting

confidence: 93%

Outcome following selective fetoscopic laser ablation for twin to twin transfusion syndrome: an 8 year national collaborative experience

Müllers

McAuliffe

Kent

et al. 2015

European Journal of Obstetrics & Gynecology and Reproductiv

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Section: Commentsupporting

confidence: 93%

Outcome following selective fetoscopic laser ablation for twin to twin transfusion syndrome: an 8 year national collaborative experience

Müllers

McAuliffe

Kent

et al. 2015

European Journal of Obstetrics & Gynecology and Reproductiv

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“…In part because of the inherent risks of twin gestations, the chronic morbidity of TTTS and the relative invasiveness of fetal intervention, TTTS pregnancies and infants may also suffer from miscarriage, preterm birth, neonatal intensive care unit admissions, respiratory distress syndrome and intraventricular hemorrhage [29]. Long term morbidity in survivors of TTTS can include renal, cardiovascular and neurodevelopmental deficits [30,31], although a number of studies have suggested that morbidity rates in TTTS cases treated with fetoscopic laser photocoagulation are no different than those observed in similarly preterm populations [32-34]. More subtle long term effects, such as those on metabolic disease and neurobehavioral outcomes, have been less comprehensively evaluated.…”

Section: Introductionmentioning

confidence: 99%

Developmental genes targeted for epigenetic variation between twin-twin transfusion syndrome children

et al. 2013

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BackgroundEpigenetic mechanisms are thought to be critical in mediating the role of the intrauterine environment on lifelong health and disease. Twin-twin transfusion syndrome (TTTS) is a rare condition wherein fetuses share the placenta and develop vascular anastomoses, which allow blood to flow between the fetuses. The unequal flow results in reciprocal hypo- and hypervolemia in the affected twins, striking growth differences and physiologic adaptations in response to this significant stressor. The donor twin in the TTTS syndrome can be profoundly growth restricted and there is likely a nutritional imbalance between the twins. The consequences of TTTS on fetal programming are unknown. This condition can now be effectively treated through the use of fetal laparoscopic procedures, but the potential for lifelong morbidity related to this condition during development is apparent. As this condition and the resulting uteroplacental discordance can play a role in the epigenetic process, we sought to investigate the DNA methylation profiles of childhood survivors of TTTS (n = 14). We focused on differences in both global measures and genome-wide CpG specific DNA methylation between donor and recipient children in this pilot study in order to generate hypotheses for further research.ResultsWe identified significant hypomethylation of the LINE1 repetitive element in the peripheral blood of donor children and subtle variation in the genome-wide profiles of CpG specific methylation most prominent at CpG sites which are targets for polycomb group repressive complexes.ConclusionsThese preliminary results suggest that coordinated epigenetic alterations result from the intrauterine environment experienced by infants with TTTS and may, at least in part, be responsible for downstream health conditions experienced by individuals surviving this condition.

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“…Speckle‐tracking studies suggest that reduced left ventricular strain is an early finding in the recipient in pre‐ or early‐stage TTTS while both ventricles are affected in later stage disease, as shown by measurements using a variety of techniques. Following successful therapy by laser ablation, signs of cardiac dysfunction regress in the majority of fetuses before delivery, but there are few reports on the effects of TTTS on cardiac function later in childhood. Herberg et al .…”

Section: Introductionmentioning

confidence: 99%

Cardiac function in 10‐year‐old twins following different fetal therapies for twin–twin transfusion syndrome

Gardiner

Matsui

Roughton

et al. 2014

Ultrasound in Obstet & Gyne

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Long-term morbidity after fetal endoscopic surgery for severe twin-to-twin transfusion syndrome

Cited by 18 publications

References 30 publications

Outcome following selective fetoscopic laser ablation for twin to twin transfusion syndrome: an 8 year national collaborative experience

Outcome following selective fetoscopic laser ablation for twin to twin transfusion syndrome: an 8 year national collaborative experience

Developmental genes targeted for epigenetic variation between twin-twin transfusion syndrome children

Cardiac function in 10‐year‐old twins following different fetal therapies for twin–twin transfusion syndrome

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