Cardiac pathophysiology in twin-twin transfusion ...

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MD1, Anthony Johnson, DO1, Ramesha Papanna, MD1, Michael Bebbington, MD1,. Helena M. Gardiner, MD PhD1. 1. The Fetal Center, Children's Memorial ...
Accepted Article

Cardiac pathophysiology in twin-twin transfusion syndrome: New insights into its evolution

Christoph Wohlmuth, MD1,2; David Boudreaux, BSc RDMS1, Kenneth J. Moise Jr, MD1, Anthony Johnson, DO1, Ramesha Papanna, MD1, Michael Bebbington, MD1, Helena M. Gardiner, MD PhD1
 1. The Fetal Center, Children’s Memorial Hermann Hospital and the Department of Obstetrics, Gynecology and Reproductive Science, UTHealth McGovern Medical School, Houston, TX, USA, 2. Department of Obstetrics and Gynecology, Paracelsus Medical University Salzburg, Salzburg, Austria.

Keywords: twin-twin transfusion syndrome, monochorionic, twin, tissue Doppler, long-axis function, myocardial performance index

Conflicts of interest: none to declare

Address for correspondence: Christoph Wohlmuth, MD Department of Obstetrics and Gynecology Fetal Medicine Division Paracelsus Medical University Müllner Hauptstrasse 48 5020 Salzburg [email protected] Phone: (832) 325-7133 Fax: (713) 512-2214

ABSTRACT Objectives This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1002/uog.17480

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In twin-twin transfusion syndrome (TTTS) unbalanced transfer of vasoactive mediators and fluid from the ‘donor’ to the ‘recipient’ alters cardiovascular function. We evaluated cardiac function in 145 monochorionic-diamniotic (MCDA) pregnancies with and without TTTS.

Accepted Article

Methods Echocardiography was performed in uncomplicated MCDA, n=26; TTTS stage I+II, n=61; TTTS stage III+IV, n=58, before selective fetoscopic laser photocoagulation (SFLP) in TTTS, and afterwards in 41 (34%) at a mean of 1.7±1.9 days. Mitral- and tricuspid annular systolic excursion (MAPSE, TAPSE), myocardial performance index (MPI), tissue Doppler velocities (E’,A’,S’) and filling pressures (E/E’) were measured and transformed into Z-scores. Ventricular pressure was estimated from peak atrioventricular regurgitation velocities.

Results Left ventricular hemodynamics were affected in early TTTS in the recipient twin. In all stages of TTTS MPI (p=0.03) and left E/E’ were elevated (p=0.002) with reduced recipient left S’ in TTTS III+IV (p