Prevalence, Spectrum, and Outcome of Right Ventricular Outflow Tract Abnormalities in Twin-twin Transfusion Syndrome: A Large, Single-center Experience

Michelfelder, Erik C.; Tan, Xiao; Cnota, James; Divanović, Allison; Statile, Christopher; Lim, Foong‐Yen; Crombleholme, Timothy M.

doi:10.1111/chd.12215

Cited by 32 publications

(60 citation statements)

References 34 publications

(93 reference statements)

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“…Our data are in agreement with previous studies [9,10,20] and suggest that the severity of TTTS is associated with an increased risk of right ventricular outflow tract abnormalities in recipients.…”

Section: Discussionsupporting

confidence: 93%

“…This might suggest that anatomical changes of the pulmonary valve that have already occurred cannot be reverted by improving hemodynamic changes and reducing vasoactive factors after laser therapy. Previous series showed lower rates of in utero regression (25-28%) and higher rates of persistence (44-50%) of PS/PA in recipient twins after fetoscopy [9,10] . Nevertheless, in those studies, postnatal follow-up was performed in only 50-72% of cases.…”

Section: Discussionmentioning

confidence: 88%

“…This might be partially explained by differences in severity case mix, over-ascertainment due to smaller sample sizes, and a variable definition of right ventricular outflow tract abnormalities in previous studies. More recently, Michelfelder et al [10] and Stagnati et al [20] reported lower rates of PS/PA (6.6%) and PS (2.1%), respectively, in larger cohorts. Differences with the current study might be explained by the retrospective nature of those studies and the fact that in the latter, fetal echocardiography was not systematic but performed only in cases with suspicion of PS/PA.…”

Section: Discussionmentioning

confidence: 94%

“…Therefore, most recipient twins show significant cardiac changes due to volume and pressure overload, including cardiomegaly, hypertrophy, tricuspid regurgitation (TR), and systolic and diastolic dysfunction [3,4] . Moreover, right ventricular outflow tract abnormalities, mainly obstructive lesions, have been reported in up to 8-21% of recipients [5][6][7][8][9][10] .…”

Section: Introductionmentioning

confidence: 99%

“…Concerning right ventricular outflow tract abnormalities, clinical experience and published series suggest that some cases revert while others may remain as structural cardiac changes, thus requiring postnatal surgical treatment [5][6][7] . However, information about evolution after laser therapy and postnatal outcomes of right ventricular outflow tract abnormalities in recipients is still scarce and mainly retrospective [9,10,16] .…”

Section: Introductionmentioning

confidence: 99%

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Rate and Outcomes of Pulmonary Stenosis and Functional Pulmonary Atresia in Recipient Twins with Twin-Twin Transfusion Syndrome

et al. 2016

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Objective: To evaluate the rate of pulmonary stenosis and functional pulmonary atresia (PS/PA) in recipient twins prior to fetal surgery for twin-twin transfusion syndrome (TTTS) and their pre- and postnatal outcomes. Methods: We carried out a prospective study including 260 cases of TTTS. Echocardiography was performed before laser surgery to detect the presence of PS/PA. The outcomes of recipients with and without PS/PA were compared. The need of postnatal cardiac interventions and the survival rate at 6 months of age were also evaluated. Results: PS was observed in 16/260 (6.2%) of recipient twins and PA in 12/260 (4.6%). After fetal surgery, 10/28 (35.7%) recipients died, 9/28 (32.1%) showed in utero regression, and 9/28 (32.1%) had persistence of PS/PA. Postnatally, seven recipients underwent percutaneous balloon pulmonary valvuloplasty, one required surgical valvotomy and one palliative surgery. Pregnancies with recipient twins with PS/PA had lower survival of at least one twin (67.9 vs. 83.6%, p = 0.045) and lower overall survival (57.1 vs. 72.8%, p = 0.015) at 6 months of age. Conclusion: PS and PA were observed in 10.8% of recipients. Among these, about one third showed persistence of pulmonary valve pathology after delivery, which stresses the need for strict follow-up.

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Section: Discussionsupporting

confidence: 93%

Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Rate and Outcomes of Pulmonary Stenosis and Functional Pulmonary Atresia in Recipient Twins with Twin-Twin Transfusion Syndrome

et al. 2016

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Echocardiographic Assessment of the Transitional Circulation

Ashrafi

Altit

2021

Echocardiography in Pediatric and Congenital Heart Disease

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Umbilical Artery Doppler Patterns and Right Ventricular Outflow Abnormalities in Twin‐Twin Transfusion Syndrome

Espinoza

Furtun

Kailin

et al. 2020

J of Ultrasound Medicine

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Objectives-To evaluate the association of abnormal Doppler velocimetric patterns in the umbilical arteries (UAs) and right ventricular outflow tract abnormalities (RVOTAs) in twin-twin transfusion syndrome (TTTS) cases. Methods-This retrospective study involved women who had laser surgery for TTTS between January 2012 and May 2018 at a single institution. The prevalence of an RVOTA in either twin was compared among TTTS cases in which both twins had positive end-diastolic flow (EDF) in the UA and those in which either twin had intermittent or persistent absent/reversed UA EDF. Nonparametric tests were used for comparisons. Logistic regression was performed to identify variables associated with an RVOTA in either twin, adjusted for moderate or severe tricuspid regurgitation, right ventricular hypertrophy, right ventricular systolic or diastolic dysfunction, the Quintero stage, and other confounders. P < .05 was considered significant. Results-A total of 126 consecutive TTTS cases were included. Right ventricular outflow tract abnormalities were seen in 8.7% (11of 126) of cases, all in recipient twins. Significant differences in the rate of RVOTAs in the recipient twin were seen between TTTS cases with intermittent absent/reversed UA EDF and those with positive UA EDF (26.9% [7 of 26] versus 3.7% [3 of 82]; P = .002]. However, no significant differences were noted among the other study groups. Intermittent absent/reversed UA EDF was associated with a significantly increased risk for an RVOTA (adjusted odds ratio, 20.6 [95% confidence interval, 3.1-138]; P = .002) after adjusting for confounders. Conclusions-Intermittent changes in vascular impedance to UA flow may contribute to the pathogenesis of acquired right-sided cardiac lesions in the recipient twin affected with TTTS.

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Prevalence, Spectrum, and Outcome of Right Ventricular Outflow Tract Abnormalities in Twin-twin Transfusion Syndrome: A Large, Single-center Experience

Cited by 32 publications

References 34 publications

Rate and Outcomes of Pulmonary Stenosis and Functional Pulmonary Atresia in Recipient Twins with Twin-Twin Transfusion Syndrome

Rate and Outcomes of Pulmonary Stenosis and Functional Pulmonary Atresia in Recipient Twins with Twin-Twin Transfusion Syndrome

Echocardiographic Assessment of the Transitional Circulation

Umbilical Artery Doppler Patterns and Right Ventricular Outflow Abnormalities in Twin‐Twin Transfusion Syndrome

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