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Aldiansyah D, Halim B, Lumbanraja SN, Asroel EM, Fahdy M, Hartono H, Thomson T. Atypical twin-to-twin transfusion syndrome case managed in a single centre in Indonesia with fetoscopic laser photocoagulation and amniopatch: 'Case Report'. Ann Med Surg (Lond) 2024; 86:3127-3132. [PMID: 38694332 PMCID: PMC11060261 DOI: 10.1097/ms9.0000000000001975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Accepted: 03/07/2024] [Indexed: 05/04/2024] Open
Abstract
Introduction and importance The diagnostic criteria for Quintero staging in twin-to-twin transfusion syndrome (TTTS) are not applicable in all cases of TTTS, such as those in which the symptoms overlap with other monochorionic twin complications such as selective intrauterine growth restriction (sIUGR). Case presentation A 25-year-old woman, G1P0A0, at 22-24 weeks' gestational age was diagnosed with TTTS, with no outstanding history of medication use during pregnancy, and no family history of genetic disorder or twin pregnancy. In the donor twin, persistently absent end-diastolic flow in the umbilical artery was observed using Doppler velocimetry. Polyhydramnios was observed in the recipient twins. The fetal weight discordance between the twins was 39%. After 2 weeks of follow-up, the authors performed fetoscopic laser photocoagulation and successfully ablated five vascular anastomoses and amnioreduction by 2.5 l. Five days after the laser surgery, the patient developed amniotic fluid leakage, and an amniopatch was performed. The authors did the caesarean section at 34 weeks because of severe preeclampsia, the donor and recipient birth weights were 1,120 g and 1,837 g, respectively (weight discordance 39%). The APGAR scores were 3/4 and 6/8, respectively. The donor twin died 6 days after delivery due to respiratory failure, and the recipient twin survived. Neonatal echocardiography of the surviving twin showed no tricuspid regurgitation. No long-term follow-up was performed. Clinical discussion The traditional diagnostic criteria for TTTS stage 3 were not met and overlapped with the diagnostic criteria for sIUGR type 2. This is the first procedure reported in Indonesia for atypical TTTS with the outcome, one twin survived. Conclusion Some TTTS cases do not meet traditional diagnostic criteria and overlap with other monochorionic twin complications.
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Affiliation(s)
- Dudy Aldiansyah
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Sumatera Utara
- Department of Obstetrics and Gynecology, Fetal Diagnosis and Therapy Unit, Division of Maternal-Fetal Medicine, Haji Adam Malik General Hospital, Medan, North Sumatera, Indonesia
| | - Binarwan Halim
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Sumatera Utara
| | - Sarma N. Lumbanraja
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Sumatera Utara
- Department of Obstetrics and Gynecology, Fetal Diagnosis and Therapy Unit, Division of Maternal-Fetal Medicine, Haji Adam Malik General Hospital, Medan, North Sumatera, Indonesia
| | - Edwin M. Asroel
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Sumatera Utara
- Department of Obstetrics and Gynecology, Fetal Diagnosis and Therapy Unit, Division of Maternal-Fetal Medicine, Haji Adam Malik General Hospital, Medan, North Sumatera, Indonesia
| | - M. Fahdy
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Sumatera Utara
- Department of Obstetrics and Gynecology, Fetal Diagnosis and Therapy Unit, Division of Maternal-Fetal Medicine, Haji Adam Malik General Hospital, Medan, North Sumatera, Indonesia
| | - Hanudse Hartono
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Sumatera Utara
| | - Thomson Thomson
- Department of Obstetrics and Gynecology, Faculty of Medicine, Universitas Sumatera Utara
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Ezazi Bojnordi T, Eslamian L, Marsoosi V, Golbabaei A, Sheikh Vatan M, Shamshirsaz AA, Eshraghi N, Ghaemi M. Doppler Finding, Cardiovascular Function Assessment, and Fetuses' Survival Following the Fetoscopic Laser in Twin-to-Twin Transfusion Syndrome. J Lasers Med Sci 2023; 14:e64. [PMID: 38318221 PMCID: PMC10843211 DOI: 10.34172/jlms.2023.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 10/08/2023] [Indexed: 02/07/2024]
Abstract
Introduction: This study aimed to evaluate the effectiveness of selective laser photocoagulation of communicating vessels (SLPCV) on cardiac function in twins with twin-to-twin transfusion syndrome (TTTS). Methods: This retrospective cohort study evaluated 178 women with twin pregnancies complicated with TTTS and scheduled for SLPCV between 16 and 26 weeks of gestation. The severity of TTTS was determined by Quintero staging and the severity of cardiovascular disorders by the CHOP (Children's Hospital of Philadelphia) score. Patient survival was evaluated through a one-month-after-birth follow-up of fetuses. Results: The study revealed significant improvements in Doppler indices in both donors and recipients after SLPCV. The CHOP score also significantly decreased after the intervention. One-month-after-birth survival rates were 55.1% in donors and 56.7% in recipients. Some Doppler indexes of fetuses before SLPCV could predict survival until one month after birth. Conclusion: The study suggests that SLPCV can improve cardiac function in fetuses with TTTS and that some Doppler indexes can predict survival outcomes. Additionally, the severity of TTTS can be a powerful indicator of the severity of cardiovascular complications.
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Affiliation(s)
- Tahmineh Ezazi Bojnordi
- Department of Obstetrics and Gynecology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Laleh Eslamian
- Department of Obstetrics and Gynecology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Vajiheh Marsoosi
- Department of Obstetrics and Gynecology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Golbabaei
- Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mehrdad Sheikh Vatan
- Department of Obstetrics and Gynecology, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza A. Shamshirsaz
- Maternal Fetal Care Center, Boston Children’s Hospital, Harvard Medical School, Boston, MA, USA
| | - Nasim Eshraghi
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Marjan Ghaemi
- Vali-E-Asr Reproductive Health Research Center, Family Health Research Institute, Tehran University of Medical Sciences, Tehran, Iran
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Faiola S, Mandalari M, Coco C, Casati D, Laoreti A, Mannarino S, Corti C, Consonni D, Cetin I, Lanna M. Long-Term Postnatal Follow-Up in Monochorionic TTTS Twin Pregnancies Treated with Fetoscopic Laser Surgery and Complicated by Right Ventricular Outflow Tract Anomalies. J Clin Med 2023; 12:4734. [PMID: 37510848 PMCID: PMC10381265 DOI: 10.3390/jcm12144734] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2023] [Revised: 07/14/2023] [Accepted: 07/16/2023] [Indexed: 07/30/2023] Open
Abstract
Right ventricular outflow tract anomalies (RVOTAs), such as pulmonary stenosis (PS), pulmonary atresia (PA), and pulmonary insufficiency (PI), are typical cardiac anomalies in monochorionic twins, and they are complicated by twin-to-twin transfusion syndrome (TTTS). The aim of this study was to conduct a long-term postnatal cardiological evaluation of prenatal RVOTAs in monochorionic diamniotic twin pregnancies complicated by TTTS and treated with fetoscopic laser surgery (FLS) and to analyze possible prenatal predictors of congenital heart disease (CHD). Prenatal RVOTAs were retrospectively retrieved from all TTTS cases treated with FLS in our unit between 2009 and 2019. Twenty-eight prenatal cases of RVOTAs (16 PI, 10 PS, 2 PA) were observed out of 335 cases of TTTS. Four cases did not reach the postnatal period. CHD was present in 17 of the remaining 24 cases (70.8%), with 10 being severe (58.8%; 10/17); nine cases of PS required balloon valvuloplasty, and one case required biventricular non-compaction cardiomyopathy. The risk of major CHD increased with prenatal evidence of PS and decreased with the gestational age at the time of TTTS and with the prenatal normalization of blood flow across the pulmonary valve. Despite treatment with FLS, the majority of monochorionic diamniotic twin pregnancies complicated by TTTS with prenatal RVOTAs had CHD at long-term follow-up.
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Affiliation(s)
- Stefano Faiola
- Fetal Therapy Unit 'Umberto Nicolini', Buzzi Children's Hospital, 20154 Milan, Italy
- Department of Woman, Mother and Neonate, Buzzi Children's Hospital, 20154 Milan, Italy
| | - Maria Mandalari
- Department of Woman, Mother and Neonate, Buzzi Children's Hospital, 20154 Milan, Italy
| | - Chiara Coco
- Department of Woman, Mother and Neonate, Buzzi Children's Hospital, 20154 Milan, Italy
| | - Daniela Casati
- Fetal Therapy Unit 'Umberto Nicolini', Buzzi Children's Hospital, 20154 Milan, Italy
- Department of Woman, Mother and Neonate, Buzzi Children's Hospital, 20154 Milan, Italy
| | - Arianna Laoreti
- Fetal Therapy Unit 'Umberto Nicolini', Buzzi Children's Hospital, 20154 Milan, Italy
- Department of Woman, Mother and Neonate, Buzzi Children's Hospital, 20154 Milan, Italy
| | - Savina Mannarino
- Pediatric Cardiology Unit, Buzzi Children's Hospital, 20154 Milan, Italy
| | - Carla Corti
- Pediatric Cardiology Unit, Buzzi Children's Hospital, 20154 Milan, Italy
| | - Dario Consonni
- Epidemiology Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy
| | - Irene Cetin
- Department of Woman, Mother and Neonate, Buzzi Children's Hospital, 20154 Milan, Italy
| | - Mariano Lanna
- Fetal Therapy Unit 'Umberto Nicolini', Buzzi Children's Hospital, 20154 Milan, Italy
- Department of Woman, Mother and Neonate, Buzzi Children's Hospital, 20154 Milan, Italy
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Lesieur E, Zaffran S, Chaoui R, Quarello E. Prenatal screening and diagnosis of pulmonary artery anomalies. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 61:445-457. [PMID: 36178851 DOI: 10.1002/uog.26078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 09/08/2022] [Accepted: 09/11/2022] [Indexed: 06/16/2023]
Abstract
Congenital pulmonary artery anomalies are rare. Their antenatal diagnosis requires good knowledge of fetal cardiac anatomy because their clinical presentation varies depending on the type and severity of the underlying lesion. Screening of these vascular anomalies can be straightforward in some cases because of significant associated consequences that are detected easily on ultrasound, while other anomalies have considerably less obvious features. There may be an associated genetic syndrome. The aim of this review was to define anomalies of the main pulmonary artery and its branches and to propose, through the identification of suspicious findings during routine antenatal heart examination, an optimal screening method for the pulmonary artery pathway. We propose that pulmonary artery anomalies can be classified antenatally into four types of disorder. Herein we describe 14 cases subgrouped accordingly as: anomalies of the pulmonary valvular region, with stenosis or atresia of the valve (n = 4); conotruncal abnormalities (n = 4); anomalies associated with abnormal origin or course of the pulmonary artery (n = 4); and anomalies associated with abnormal growth of the pulmonary artery and its branches (n = 2). We highlight the need to differentiate the three-vessel view from the three-vessel-and-trachea view when assessing a fetus with a congenital pulmonary artery anomaly. © 2022 The Authors. Ultrasound in Obstetrics & Gynecology published by John Wiley & Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- E Lesieur
- Prenatal Diagnosis Center, Department of Obstetrics and Gynecology, Timone Hospital, Aix-Marseille University, Marseille, France
- UMR 7268 ADES, Aix-Marseille University, CNRS, EFS, Marseille, France
| | - S Zaffran
- Aix-Marseille University, INSERM, MMG, U1251, Marseille, France
| | - R Chaoui
- Center for Prenatal Diagnosis and Human Genetics, Berlin, Germany
| | - E Quarello
- Screening and Diagnosis Unit, Department of Obstetrics and Gynecology, Saint Joseph Hospital, Marseille, France
- IMAGE2 Center, Marseille, France
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