Twin-twin transfusion syndrome: the 'Select' procedure

Area of Science:

• Perinatology
• Fetal Medicine
• Minimally Invasive Surgery

Background:

• Twin-twin transfusion syndrome (TTTS) presents significant risks for perinatal morbidity and mortality due to placental vascular connections.
• Early, severe TTTS cases may not respond to conventional treatments like serial amniocenteses.

Observation:

• A case of early, severe TTTS refractory to amniocenteses is presented.
• Prenatal sonography with Doppler identified a specific arteriovenous anastomosis.
• Fetoscopic intervention at 23 weeks' gestation targeted only the identified vascular connection.

Findings:

• Superselective laser coagulation of the single arteriovenous connection led to rapid resolution of TTTS.
• The pregnancy resulted in the delivery of two healthy infants at 33 weeks' gestation.

Implications:

• Interruption of a single arteriovenous connection can reverse the fatal pathophysiology of TTTS.
• The novel 'Select' procedure (sonographically evaluated, laser-endoscopic coagulation for twins) offers a successful treatment option.
• This technique demonstrates the potential for targeted intervention in complex fetal conditions.