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PS-019 Childhood Cardiac Outcome Of Twin-twin Transfusion Syndrome After Intrauterine Laser Treatment: An Echocardiographic Study Of Ventricular Function
  1. C Pegelow Halvorsen1,
  2. LA Mohlkert2,
  3. M Norman2,
  4. SE Sonesson3
  1. 1Clinical Science and Education, Karolinska Institutet, Stockholm, Sweden
  2. 2Clinical Science Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
  3. 3Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden

Abstract

Background and aim Intrauterine laser treatment of placental vessels is used to alleviate abnormal circulatory load and cardiac morbidity affecting fetuses with twin-twin transfusion syndrome (TTTS). As the final cardiac outcome after such intervention is not known, we conducted this childhood follow-up study of cardiac function in twins treated with intrauterine laser for TTTS.

Methods and results Nineteen TTTS pairs (11 male, 8 female) with a mean age of 4.5 (range 1.1–9.9) years were assessed with echocardiography 2D, Doppler, DTI, 3D and speckle tracking, and compared with nineteen age- and gender-matched singletons.

Recipients had a lower left ventricular E/A ratio compared with their donor twins [1.48(0.35) vs. 1.66(0.28), p < 0.05] but not compared with singleton controls, and all but one observation were within normal reference limits. There was no significant difference in the right ventricular E/A ratio [1.26(0.28) vs. 1.41(0.28), p = 0.06], but recipients showed a slightly lower right ventricular e’/a’ ratio when DTI was used. TTTS twins had smaller longitudinal left and right ventricular dimensions than controls. Besides a marginally lower ventricular strain in donors compared with controls, speckle tracking could not demonstrate any group differences in systolic ventricular function.

Conclusion Despite significantly different fetal cardiac loading conditions, survivors of laser-treated TTTS show only minor within-pair differences in diastolic cardiac function at follow-up. Cardiac function in TTTS twins compare well to singleton controls, suggesting a favourable long-term outcome.

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