Doppler assessment of the effect of laser photocoagulation of communicating vessels in twin-twin transfusion syndrome

R. A. Quintero, C. A. Carreno, M. Kruger, M. King, C. Sndz, R. Romero, M. L. Evans

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Abstract

OBJECTIVE: laser photocoagulation of communicating vessels (LPCV) has been proposed for the management of twin-twin transfusion syndrome (TTTS). Our purpose was to study the hemodynamic effect of this procedure in the venous and arterial territories of the donor and the recipient twin. STUDY DESIGN: Doppler waveform analysis of the umbilical artery (l'A) and the middle cerebral arter)'was performed in the donor and the recipient twin before and one day after LPCV. The ductus venosus (DV), the right hepatic vein and the inferior vena cava were also explored. Measurements were done when three consecutive waveforms were recorded, in the absence of fetal breathing, movement or arrhythmia. Information was considered complete if pre- and post-operative data was available for both fetuses. Percent differences were analyzed with repeated measures AN OVA and paired Student's T-test. RESULTS: Fifteen patients were referred for possible LPCV. One patient was excluded because of severe amniochorion separation, and 14 patients underwent surgery. Eight of 14 patients had hydropic fetuses on presentation, 12 had failed serial arnniodrainage and 2 patients had no previous therapetitic procedures. Fifty percent of patients had an anterior placenta. LPCV was performed at the level of the dividing membrane. Both fetuses survived in 5 cases, 3 cases had one survivor, and both fetuses died in 6 cases. Complete information for the UA was available in 8 patients. A significant post-operative decrease in the pulsatility index (PI) of the UA of the donor fetus was associated with survival (p = 0.02). Complete information for the DV was available in 7 patients. A significant post-operative drop in the peak velocity and in the time-average forward velocity (VTI) of the DV of the recipient twin was also associated with survival (p < 0.05). No significant differences were seen in the remaining vessels. CONCLUSIONS: LPCV is associated with demonstrable Doppler changes in the arterial and venous system of donor and recipient fetuses. A decrease in the PI of the UA of the donor fetus and a decrease in the peak velocity and VTI of the DV of the recipient fetus are associated with an increased likelihood of survival. Lack of Doppler changes may reflect ineffective therapy. Doppler changes in the opposite direction may indicate a possible detrimental effect of the surgery. Pulsed Doppler may thus have diagnostic and prognostic value in cases of TTTS treated with LPCV.

Original languageEnglish (US)
Pages (from-to)S85
JournalActa Diabetologica Latina
Volume176
Issue number1 PART II
StatePublished - Dec 1 1997

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ASJC Scopus subject areas

  • Internal Medicine
  • Endocrinology, Diabetes and Metabolism
  • Endocrinology

Cite this

Quintero, R. A., Carreno, C. A., Kruger, M., King, M., Sndz, C., Romero, R., & Evans, M. L. (1997). Doppler assessment of the effect of laser photocoagulation of communicating vessels in twin-twin transfusion syndrome. Acta Diabetologica Latina, 176(1 PART II), S85.