Cardiac function in TTTS twins after laser coagulation

Introduction
Introduction: Cardiac function in twin pregnancies complicated by twin-to-twin transfusion syndrome (TTTS) is an important issue in order to understand the modifications that any intervention aimed to solve the blood transfusion can determine on the surviving fetuses. Many studies have shown that in the long term, after laser coagulation (LC) of severe TTTS syndrome, cardiac function and blood pressure return to normal in the major- ity of surviving twins. This indicates that the preceding cardiac dysfunction regresses once LC has removed the underlying cause. However, a reported increased in the prevalence of pulmonary stenosis despite successful LC justifies the need for prenatal and postnatal cardiac surveillance.

Material and methods
In our data of 28 pairs of twins complicated by TTTS and undergoing LC, we observed ab- normal prenatal cardiac findings before treatment and the postnatal occurrence of some structural heart defects. One twin recipient with hydrops and functional pulmonary atresia had the same features at postnatal follow-up; another twin recipient with fetal hydrops, and mitral and tricuspid valve regurgitation presented with moderate pulmonary stenosis postnatally.

Results
One fifth of all TTTS recipient twins show congenital and/or acquired diseases, i.e. right ventricle outflow tract obstruction (RVOTO), PA, or PS. Laser coagulation in severe stages can solve the blood transfusion but does not solve the acquired CHD (such as right ventricular outflow obstruction and pulmonary valve atresia).

Conclusions
Laser coagulation should always be performed before cardiac function deteriorates, if possible.