OC71: Fetal cardiac function evaluated with the modified myocardial performance index in twin–twin transfusion syndrome and impact of laser therapy

Abstract

Oral communication abstracts umbilical artery. Wall motion filter was kept at less than 100 MHz. Waveforms were assessed in triplicate. Percent AEDV (%AEDV) was calculated as time of the cycle spent in AEDV divided by total cardiac cycle × 100. Follow-up Dopplers were performed 16-24 hours later. IUFD was recorded if the donor twin died any time prior to delivery. A p < 0.05 was considered statistically significant. Results: Sixteen patients with pre-operative AEDV were identified during the study period, of which 5 were associated with IUFD-D. Gestational age at the time of the procedure, number of anastomoses lasered, operating time or placental location were not different between patients with or without IUFD-D. The mean pre-op %AEDV was significantly higher in patients with IUFD-D than in those without (42.7% vs. 27.1%, respectively, p = 0.029). A %AEDV > 35 was 18 times more likely to be associated with IUFD-D (95% CI 1.2-260). AEDV resolved in 8 patients after surgery, with a mean %AEDV of 26.9% vs. 37% in those in whom AEDV did not resolve. However, this difference was not statistically significant. Conclusion: A %AEDV > 35 is associated with an increased risk of IUFD of the donor twin in TTTS patients treated with SLPCV. A high %AEDV is more predictive of IUFD-D than the lack of resolution of AEDV after surgery. Assessment of %AEDV should be considered part of the pre-operative evaluation of TTTS patients.

The (Pulsed-Wave) Doppler Fetal Myocardial Performance Index: Technical Challenges, Clinical Applications and Future Research

“…From early in the evolution of TTTS, both right and left Mod-MPIs of the recipient twin are systematically higher than those of the donor, which often remain within the normal range [7,19,21,22,38,57,68,89,90,91,92,93,94]. Stirnemann et al [18] and Quintero et al [95] found significant myocardial dysfunction in the recipient twins in up to 55 and 44% of stage 1 cases respectively.…”

Diagnosis and Management of Selective Fetal Growth Restriction in Monochorionic Twins

“…13 Because of the important differences in fetal weight, the collision point where the two systolic waveforms meet is shifted towards the smaller twin's cord insertion. 27 This situation might reflect a state of high output cardiac failure produced because the larger twin is pumping a proportion of the fetoplacental volume of the smaller one. However, there is a substantially higher risk of acute feto-fetal transfusion accidents, which may have dire consequences due to the magnitude of the transfusion.…”