Sequential selective laser photocoagulation of communicating vessels in twin-twin transfusion syndrome

Rubén A. Quintero, Keisuke Ishii, Ramen H. Chmait, Patricia W. Bornick, Mary H. Allen, Eftichia V. Kontopoulos

Research output: Contribution to journalArticle

96 Citations (Scopus)

Abstract

Objective. We have previously described the selective laser photocoagulation of communicating vessels (SLPCV) technique for the treatment of twin-twin transfusion syndrome (TTTS). Because TTTS is thought to result from a net transfer of blood from the donor twin to the recipient twin, we hypothesized that lasering the arteriovenous anastomoses from the donor to the recipient (AVDRs) first (sequential SLPCV or SQLPCV) would result in an improved hemodynamic status and decreased likelihood of intrauterine fetal demise of the donor twin (IUFD-D). Materials and methods. The diagnosis of TTTS was made by ultrasound showing the combined presence of a maximum vertical pocket ≥ 8 cm in one sac and ≤2 cm in the other in a monochorionic/diamniotic twin pregnancy. Triplet pregnancies and monoamniotic pregnancies were excluded. Severity of TTTS was assessed using the Quintero staging system. All vascular anastomoses were endoscopically identified and classified as AVDR (AV from donor to recipient), AVRD (AV from recipient to donor), arterio-arterial (AA), or veno-venous (VV). The surgical procedure was coded as SQLPCV if all AVDRs were lasered first. Outcome measures included intrauterine fetal demise and perinatal survival. Results. One hundred and ninety-three TTTS patients (137 SQLPCV, 56 SLPCV) underwent surgery from May 2003 to August 2005. Gestational age at surgery or at delivery, Stage, patent anastomoses, or persistent/reverse TTTS were not different between the groups. IUFD-D was significantly lower in the SQLPCV than in the SLPCV group (7.3% vs 21.4%, respectively, p = 0.005). Dual perinatal survival was significantly higher in the SQLPCV than in the SLPCV group (73.7% vs 57.1%, respectively, p = 0.02), although the incidence of at least one survivor was not different between the groups (90.5% vs 87.5%, respectively). Logistic regression showed SQLPCV, but not placental location, operating time or number of anastomoses to be significantly associated with a decreased likelihood of IUFD-D (p = 0.007). Conclusion. SQLPCV is associated with a decreased likelihood of IUFD-D and an increased rate of dual survivors compared to SLPCV. SQLPCV represents both an anatomical and functional surgical approach to the laser treatment of twin-twin transfusion syndrome.

Original languageEnglish
Pages (from-to)763-768
Number of pages6
JournalJournal of Maternal-Fetal and Neonatal Medicine
Volume20
Issue number10
DOIs
StatePublished - Sep 6 2007

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Fetofetal Transfusion
Light Coagulation
Fetal Death
Lasers
Tissue Donors
Survivors
Triplet Pregnancy
Arteriovenous Anastomosis
Twin Pregnancy
Survival
Blood Donors
Gestational Age
Blood Vessels
Logistic Models
Hemodynamics
Outcome Assessment (Health Care)
Pregnancy
Incidence
Therapeutics

Keywords

  • Laser therapy
  • Twin-twin transfusion syndrome
  • Ultrasound

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Obstetrics and Gynecology

Cite this

Sequential selective laser photocoagulation of communicating vessels in twin-twin transfusion syndrome. / Quintero, Rubén A.; Ishii, Keisuke; Chmait, Ramen H.; Bornick, Patricia W.; Allen, Mary H.; Kontopoulos, Eftichia V.

In: Journal of Maternal-Fetal and Neonatal Medicine, Vol. 20, No. 10, 06.09.2007, p. 763-768.

Research output: Contribution to journalArticle

Quintero, Rubén A. ; Ishii, Keisuke ; Chmait, Ramen H. ; Bornick, Patricia W. ; Allen, Mary H. ; Kontopoulos, Eftichia V. / Sequential selective laser photocoagulation of communicating vessels in twin-twin transfusion syndrome. In: Journal of Maternal-Fetal and Neonatal Medicine. 2007 ; Vol. 20, No. 10. pp. 763-768.
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AU - Allen, Mary H.

AU - Kontopoulos, Eftichia V.

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N2 - Objective. We have previously described the selective laser photocoagulation of communicating vessels (SLPCV) technique for the treatment of twin-twin transfusion syndrome (TTTS). Because TTTS is thought to result from a net transfer of blood from the donor twin to the recipient twin, we hypothesized that lasering the arteriovenous anastomoses from the donor to the recipient (AVDRs) first (sequential SLPCV or SQLPCV) would result in an improved hemodynamic status and decreased likelihood of intrauterine fetal demise of the donor twin (IUFD-D). Materials and methods. The diagnosis of TTTS was made by ultrasound showing the combined presence of a maximum vertical pocket ≥ 8 cm in one sac and ≤2 cm in the other in a monochorionic/diamniotic twin pregnancy. Triplet pregnancies and monoamniotic pregnancies were excluded. Severity of TTTS was assessed using the Quintero staging system. All vascular anastomoses were endoscopically identified and classified as AVDR (AV from donor to recipient), AVRD (AV from recipient to donor), arterio-arterial (AA), or veno-venous (VV). The surgical procedure was coded as SQLPCV if all AVDRs were lasered first. Outcome measures included intrauterine fetal demise and perinatal survival. Results. One hundred and ninety-three TTTS patients (137 SQLPCV, 56 SLPCV) underwent surgery from May 2003 to August 2005. Gestational age at surgery or at delivery, Stage, patent anastomoses, or persistent/reverse TTTS were not different between the groups. IUFD-D was significantly lower in the SQLPCV than in the SLPCV group (7.3% vs 21.4%, respectively, p = 0.005). Dual perinatal survival was significantly higher in the SQLPCV than in the SLPCV group (73.7% vs 57.1%, respectively, p = 0.02), although the incidence of at least one survivor was not different between the groups (90.5% vs 87.5%, respectively). Logistic regression showed SQLPCV, but not placental location, operating time or number of anastomoses to be significantly associated with a decreased likelihood of IUFD-D (p = 0.007). Conclusion. SQLPCV is associated with a decreased likelihood of IUFD-D and an increased rate of dual survivors compared to SLPCV. SQLPCV represents both an anatomical and functional surgical approach to the laser treatment of twin-twin transfusion syndrome.

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