Prevalence and progression of recipient‐twin cardiomyopathy in early‐stage twin–twin transfusion syndrome

Habli, Mounira; Michelfelder, Erik C.; Cnota, James; Wall, David J. N.; Polzin, William; Lewis, David; Lim, Foong Yen; Crombleholme, Timothy M.

doi:10.1002/uog.10117

Cited by 43 publications

(45 citation statements)

References 21 publications

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“…This has led to the development of cardiovascular scoring systems to characterize the severity of cardiac involvement in TTTS. 508,509 The Cincinnati staging system uses fetal echocardiography to detect recipienttwin cardiomyopathy and modifies staging on the basis of the severity of recipient-twin echocardiographic abnormalities. The severity of recipient-twin cardiomyopathy is scored as an aggregate impression of the severity of AV valve regurgitation, ventricular wall hypertrophy, and ventricular function as assessed by the MPI 508 (Table 17).…”

Section: Diagnosis and Hemodynamic Assessmentmentioning

confidence: 99%

Diagnosis and Treatment of Fetal Cardiac Disease

Donofrio¹,

Moon-Grady²,

Hornberger³

et al. 2014

Circulation

973

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

973

543

View full text Add to dashboard Cite

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“…Patient desires are always considered, but routinely, patients at our center are treated with SFLP if they are in Quintero stage III or above or if they are in stage I or II with cardiomyopathy findings. Habli et al 8 recently published an analysis of our center's experience with early-stage TTTS. Those managed initially with observation or amnioreduction, including 54% who experienced disease progression and underwent salvage SFLP, had better survival than those managed by primary SFLP.…”

Section: Discussionmentioning

confidence: 98%

“…4 Outcomes analyses for a portion of this cohort have previously been reported. 8 Pregnancies with Doppler abnormalities or hydrops that would meet classification for Quintero stage III or IV were excluded. Cardiomyopathy was defined as presence of ventricular wall hypertrophy (on qualitative assessment), atrioventricular valve regurgitation, and ventricular dysfunction with elevated myocardial performance index (MPI) values above 2 standard deviations of the mean.…”

Section: Methodsmentioning

confidence: 99%

“…8 We aimed to further analyze the very first echocardiogram from this group of early-stage TTTS with initially no overt cardiac pathology, to evaluate for differences among RTs who did versus did not subsequently develop cardiomyopathy. Parameters of diastolic function were selected for evaluation because previous work has demonstrated that diastolic dysfunction is a commonly observed abnormality in RTs and has been associated with the severity of RT cardiomyopathy.…”

mentioning

confidence: 99%

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Diastolic Dysfunction and Cerebrovascular Redistribution Precede Overt Recipient Twin Cardiomyopathy in Early-Stage Twin-Twin Transfusion Syndrome

Votava‐Smith

Habli

Cnota

et al. 2015

Journal of the American Society of Echocardiography

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“…Literatürde amnioredüksiyonun faydası hakkında fikir birliği tam olarak oluşmamıştır. Bir çalışmada amniyoredüksiyo-nun, perinatal mortaliteyi azaltmadığı [13] gösterilse de yapılan daha yeni bir çalışmada ikizlerden birinin 28 hafta civarında doğumuyla sürvi oranlarını %50'ye kadar arttırdığı gösterilmiştir [14]. Quintero sınıflamasına göre, Evre 1 ve evre 2'de amniyoredüksiyonun değerlendirildiği bir çalışmada hastaların % 41'inde düzelme sağlanmıştır [12].…”

Section: Discussionunclassified

Effect of Amnioreduction on Maternal and Perinatal Outcomes in Patients with Twin - Twin Transfusion Syndrome

2016

Ann Clin Anal Med

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ÖzetAmaç: İkiz -ikiz transfüzyon sendromu (İİTS) tanısı konulan olgularda amniyoredüksiyon yapılmasının perinatal sonuçlarla ilişkisini belirlemek. Gereç ve Yöntem: İİTS tanısı alan 42 hasta çalışmaya dahil edildi. Bu hastalardan amnioredüksiyon yapılan 14 hasta çalışma grubunu, amnioredüksiyon yapılma-yan 28 hasta kontrol grubunu oluşturdu. Amniyoredüksiyonun ikizler üzerin-de doğum haftası, doğum ağırlığı, yenidoğan yoğun bakım ihtiyacı ve perinatal mortalite üzerine etkileri retrospektif olarak medikal kayıtlardan elde edildi. P değeri 0.05 değerinin altında anlamlı kabul edildi. Bulgular: Amniyoredüksiyon yapılan hastalarda doğum haftası 28.7 ± 4.1 iken kontrol grubunda 31.8 ± 4.9 olarak bulundu. Amniyoredüksiyon yapılan hastalarda, 32 hafta altı 12 (%85.7) ve 28 hafta altı 10 (%71.4) hastada doğum görülürken kontrol grubunda, 32 hafta altı 12 (%43.1) ve 28 hafta altı 9 (%32.1) hastada doğum gerçekleşti (P<0.05). Amniyoredüksiyon yapılan hastalarda alıcı ikizin doğum ağırlığı 1385 ± 711 gr iken kontrol grubunda 2104 ± 741 gr olarak bulundu (P<0.05). Amniyoredüksiyon yapılan hastalarda yenidoğanların 24'ü (%92.3) yenidoğan yoğun bakım ihtiyacı duyarken kontrol grubu yenidoğanla-rının 40'ının (% 71.4) yenidoğan yoğun bakım ihtiyacı olmuştur (p=0.11). Tartışma: Çalışmamızda amniyoredüksiyon İİTS olgularında perinatal sonuçlar üzerine olumlu bir etkisi bulunamamıştır. Anahtar Kelimelerİkiz -İkiz Transfüzyon Sendromu; Amniyoredüksiyon; Maternal Sonuç; Perinatal Sonuç Abstract Aim: To assess the effect of amnioreduction on perinatal outcomes in patients with twin -twin transfusion syndrome (TTTS). Material and Method: 42 patients with TTTS were enrolled into this study. 14 of 42 patients who underwent amnioreduction formed the study group and 28 of 42 patients who did not undergo amnioreduction formed the control group. Effects of amnioreduction on average week of birth, birth weight, need of neonatal intensive care and perinatal mortality were gathered from medical records retrospectively. P score under 0.05 was accepted as significant. Results: Average week of birth of women who underwent amnioreduction was 28.7 ± 4.1 however it was 31.8 ± 4.9 on control group. Although number of births under 32 weeks is 12 (85.7%) and under 28 weeks is 10 (71.4%) on patients who underwent amnioreduction, it was 12 (43.1%) for under 32 weeks and 9 (32.1%) for under 28 weeks in control group (P<0.05). Birth weight of recipient twin was 1385 ± 711 gr in amnioreduction group and 2104 ± 741 gr in control group (P<0.05). 40 newborns (71.4%) of the control group needed neonatal intensive care however 24 newborns (92.3%) of the amnioreduction group needed neonatal intensive care (p=0.11). Discussion: In this study, we did not find any positive effect of amnioreduction on perinatal outcomes in pregnant women with TTTS.

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Prevalence and progression of recipient‐twin cardiomyopathy in early‐stage twin–twin transfusion syndrome

Cited by 43 publications

References 21 publications

Diagnosis and Treatment of Fetal Cardiac Disease

Diagnosis and Treatment of Fetal Cardiac Disease

Diastolic Dysfunction and Cerebrovascular Redistribution Precede Overt Recipient Twin Cardiomyopathy in Early-Stage Twin-Twin Transfusion Syndrome

Effect of Amnioreduction on Maternal and Perinatal Outcomes in Patients with Twin - Twin Transfusion Syndrome

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