Abstract
Introduction: Treatment of the twin-twin transfusion syndrome (TTTS) via sequential selective laser photocoagulation of communicating vessels (SQLPCV) mandates ablation of donor-to-recipient arteriovenous anastomoses first. It is hypothesized that SQLPCV facilitates intraoperative transfusion to the donor, thereby minimizing donor hypovolemia and anemia. We sought to determine if postoperative changes in fetal middle cerebral artery-peak systolic velocities (MCA-PSV) support this hypothesis. Materials and Methods: Patients undergoing preferential SQLPCV for TTTS had MCA-PSV measured 1 day before surgery and on postoperative day 1 (POD-1). Fetal anemia was defined as an MCA-PSV ≥1.5 multiples of the median (MoM). Exclusions included: POD-1 demise, missing MCA-PSV data, or gestational age <18 weeks. Results: Study criteria were met by 139 patients. Mean MCA-PSV in recipients increased from 0.97 to 1.15 MoM postoperatively (p < 0.0001). Donor mean MCA-PSV remained stable at 1.00 MoM preoperatively and 0.98 MoM postoperatively (p = 0.272). Nine fetuses, 6 donors and 3 recipients, had preoperative anemia; SQLPCV was not attempted in the 3 anemic recipients. Postoperatively, the proportion of donors with anemia remained stable (increase 3.6%, p = 0.419), and the proportion of recipients with anemia increased (increase 12.2%, p = 0.009). Discussion: Our findings confirm the presumed physiological basis for the SQLPCV treatment of TTTS.
| Original language | English |
|---|---|
| Pages (from-to) | 140-144 |
| Number of pages | 5 |
| Journal | Fetal Diagnosis and Therapy |
| Volume | 28 |
| Issue number | 3 |
| DOIs | |
| State | Published - Oct 1 2010 |
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Keywords
- Fetal anemia
- Middle cerebral artery Doppler
- Operative fetoscopy
- Sequential laser surgery
- Twin-twin transfusion syndrome
ASJC Scopus subject areas
- Obstetrics and Gynecology
- Pediatrics, Perinatology, and Child Health
- Embryology
- Radiology Nuclear Medicine and imaging
Cite this
Postoperative middle cerebral artery peak systolic velocity changes confirm physiological principles of the sequential laser technique for twin-twin transfusion syndrome. / Pathak, Bhuvan; Quintero, Ruben; Kontopoulos, Eftichia; Assaf, Samer; Miller, David; Chmait, Ramen H.
In: Fetal Diagnosis and Therapy, Vol. 28, No. 3, 01.10.2010, p. 140-144.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Postoperative middle cerebral artery peak systolic velocity changes confirm physiological principles of the sequential laser technique for twin-twin transfusion syndrome
AU - Pathak, Bhuvan
AU - Quintero, Ruben
AU - Kontopoulos, Eftichia
AU - Assaf, Samer
AU - Miller, David
AU - Chmait, Ramen H.
PY - 2010/10/1
Y1 - 2010/10/1
N2 - Introduction: Treatment of the twin-twin transfusion syndrome (TTTS) via sequential selective laser photocoagulation of communicating vessels (SQLPCV) mandates ablation of donor-to-recipient arteriovenous anastomoses first. It is hypothesized that SQLPCV facilitates intraoperative transfusion to the donor, thereby minimizing donor hypovolemia and anemia. We sought to determine if postoperative changes in fetal middle cerebral artery-peak systolic velocities (MCA-PSV) support this hypothesis. Materials and Methods: Patients undergoing preferential SQLPCV for TTTS had MCA-PSV measured 1 day before surgery and on postoperative day 1 (POD-1). Fetal anemia was defined as an MCA-PSV ≥1.5 multiples of the median (MoM). Exclusions included: POD-1 demise, missing MCA-PSV data, or gestational age <18 weeks. Results: Study criteria were met by 139 patients. Mean MCA-PSV in recipients increased from 0.97 to 1.15 MoM postoperatively (p < 0.0001). Donor mean MCA-PSV remained stable at 1.00 MoM preoperatively and 0.98 MoM postoperatively (p = 0.272). Nine fetuses, 6 donors and 3 recipients, had preoperative anemia; SQLPCV was not attempted in the 3 anemic recipients. Postoperatively, the proportion of donors with anemia remained stable (increase 3.6%, p = 0.419), and the proportion of recipients with anemia increased (increase 12.2%, p = 0.009). Discussion: Our findings confirm the presumed physiological basis for the SQLPCV treatment of TTTS.
AB - Introduction: Treatment of the twin-twin transfusion syndrome (TTTS) via sequential selective laser photocoagulation of communicating vessels (SQLPCV) mandates ablation of donor-to-recipient arteriovenous anastomoses first. It is hypothesized that SQLPCV facilitates intraoperative transfusion to the donor, thereby minimizing donor hypovolemia and anemia. We sought to determine if postoperative changes in fetal middle cerebral artery-peak systolic velocities (MCA-PSV) support this hypothesis. Materials and Methods: Patients undergoing preferential SQLPCV for TTTS had MCA-PSV measured 1 day before surgery and on postoperative day 1 (POD-1). Fetal anemia was defined as an MCA-PSV ≥1.5 multiples of the median (MoM). Exclusions included: POD-1 demise, missing MCA-PSV data, or gestational age <18 weeks. Results: Study criteria were met by 139 patients. Mean MCA-PSV in recipients increased from 0.97 to 1.15 MoM postoperatively (p < 0.0001). Donor mean MCA-PSV remained stable at 1.00 MoM preoperatively and 0.98 MoM postoperatively (p = 0.272). Nine fetuses, 6 donors and 3 recipients, had preoperative anemia; SQLPCV was not attempted in the 3 anemic recipients. Postoperatively, the proportion of donors with anemia remained stable (increase 3.6%, p = 0.419), and the proportion of recipients with anemia increased (increase 12.2%, p = 0.009). Discussion: Our findings confirm the presumed physiological basis for the SQLPCV treatment of TTTS.
KW - Fetal anemia
KW - Middle cerebral artery Doppler
KW - Operative fetoscopy
KW - Sequential laser surgery
KW - Twin-twin transfusion syndrome
UR - http://www.scopus.com/inward/record.url?scp=78049424262&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=78049424262&partnerID=8YFLogxK
U2 - 10.1159/000319803
DO - 10.1159/000319803
M3 - Article
VL - 28
SP - 140
EP - 144
JO - Fetal Diagnosis and Therapy
JF - Fetal Diagnosis and Therapy
SN - 1015-3837
IS - 3
ER -