eISSN: 2449-6731
ISSN: 2449-6723
Prenatal Cardiology
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Basic research

Cardiac function in TTTS twins after laser coagulation

Valentina I. Tsibizova
Tatiana М. Pervunina
Eduard V. Komlichenko
Igor E. Govorov
1, 2
Igor I. Averkin
Alexander D. Makatsariya
Gian Carlo Di Renzo
3, 4

  1. Almazov National Medical Research Centre, Health Ministry of the Russian Federation, Saint Petersburg, Russia
  2. Department of Women’s and Children’s Health, Karolinska Institute, Solna, Sweden
  3. Department of Obstetrics and Gynaecology, I.M. Sechenov First State University, Moscow, Russia
  4. Centre for Perinatal and Reproductive Medicine and Department of Obstetrics and Gynaecology, University of Perugia, Italy
Prenat Cardio 2020; 10(1); 37-47
Online publish date: 2020/08/21
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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.

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).

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


laser coagulation, TTTS, RVOTO, pulmonary atresia, pulmonary stenosis, twins

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