Profiling fetal cardiac function in twin-twin transfusion syndrome
J J Stirnemann1, M Mougeot, F Proulx
1Department of Obstetrics and Gynecology, GHU Necker Enfants Malades, University Paris Descartes, Paris, France.
Summary
Assessing recipient twin cardiac function in twin-twin transfusion syndrome (TTTS) quantitatively identifies cardiomyopathy. This cardiac profiling aids in disease staging, distinguishing cases with myocardial dysfunction when laser coagulation is the primary treatment.
Area of Science:
- Fetal Medicine
- Cardiology
- Perinatology
Background:
- Cardiomyopathy in the recipient twin is a key indicator of twin-twin transfusion syndrome (TTTS) severity.
- Quantitative assessment of cardiac function may improve disease staging and management.
Purpose of the Study:
- To quantitatively describe cardiac function in the recipient twin of TTTS pregnancies.
- To evaluate the predictive value of preoperative cardiac function profiles for perinatal outcomes.
- To compare identified cardiac profiles with the Quintero staging system.
Main Methods:
- Fetal echocardiography was performed before laser coagulation in monochorionic pregnancies with TTTS.
- Unsupervised classification analysis identified distinct cardiac function profiles in recipient twins.
- Perinatal death was used as the primary outcome to assess predictive value.
Main Results:
- Three preoperative cardiac profiles were identified, reflecting progressive cardiomyopathy.
- No significant correlation was found between cardiac profiles and pregnancy outcomes.
- 55% of Quintero Stage 1 cases exhibited significant recipient twin cardiac dysfunction.
Conclusions:
- Quantitative cardiac profiling in the recipient twin can assess progressive cardiomyopathy in TTTS.
- Cardiac profiling aids in identifying significant myocardial dysfunction, surpassing current staging methods.
- When fetoscopic laser coagulation is the first-line treatment, cardiomyopathy assessment does not impact pregnancy outcome.
