Geburtshilfe Frauenheilkd 2014; 74 - PO_Geb01_16
DOI: 10.1055/s-0034-1388040

Perinatal outcome after laser therapy of recipient twins affected by right ventricle outflow tract obstruction

JU Ortiz 1, 2, JM Martinez 1, N Masoller 1, E Eixarch 1, F Crispi 1, O Gómez 1, SM Lobmaier 1, 2, M Bennasar 1, E Gratacós 1
  • 1BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clinic), IDIBAPS, University of Barcelona, Barcelona, Spain
  • 2Frauenklinik am Klinikum rechts der Isar der Technischen Universität München, Perinatalmedizin, München, Germany

Objective: To describe the prevalence and evolution of pulmonary stenosis or atresia (PS-A) in recipient twins after selective laser photocoagulation of communicating vessels (SLPCV) in twin-to-twin transfusion syndrome (TTTS).

Methods: 260 cases of TTTS were managed by SLPCV during a 6-year period. A fetal echocardiographic evaluation of all recipient twins before and after laser therapy was performed, in order to assess in utero resolution or progression of the pulmonary obstruction. The diagnosis of PS-A was confirmed by postnatal pediatric cardiologist examination or autopsy in cases of perinatal death. Other main outcome items were perinatal survival and neurological morbidity up to 6th month of postnatal life.

Results: The median gestational age at diagnosis and procedure was 19.5 weeks (15.6 – 27.4). There were 28/260 (10.8%) recipients with PS-A, 11 of them (39.3%) had a perinatal death and in 9 (32.1%) intrauterine resolution of the PS-A occurred. This was confirmed postnatally, and 8 infants (28.6%) required balloon valvuloplasty before six months of life. No cases of brain damage were detected among the survivors, as assessed by clinical examination or imaging techniques.

Conclusions: The prevalence of PS-A in our population of recipient twins is similar to previously published data. Although initially described as a functional cardiac anomaly, thus being potentially reversible in utero after laser therapy, strict follow up is warranted. This group of recipient twins have a high risk of adverse perinatal outcome, since only 1/3 were healthy infants at 6 months of life.