Twin-twin transfusion syndrome: the influence of intrauterine laser photocoagulation on arterial distensibility in childhood

Gardiner, Helena M., Taylor, Myles J.O., Karatza, Ageliki, Vanderheyden, Tina, Huber, Agnes, Greenwald, Stephen E., Fisk, Nicholas M. and Hecher, Kurt (2003) Twin-twin transfusion syndrome: the influence of intrauterine laser photocoagulation on arterial distensibility in childhood. Circulation, 107 14: 1906-1911. doi:10.1161/01.CIR.0000060543.64250.80


Author Gardiner, Helena M.
Taylor, Myles J.O.
Karatza, Ageliki
Vanderheyden, Tina
Huber, Agnes
Greenwald, Stephen E.
Fisk, Nicholas M.
Hecher, Kurt
Title Twin-twin transfusion syndrome: the influence of intrauterine laser photocoagulation on arterial distensibility in childhood
Journal name Circulation   Check publisher's open access policy
ISSN 0009-7322
1524-4539
Publication date 2003-04-15
Year available 2003
Sub-type Article (original research)
DOI 10.1161/01.CIR.0000060543.64250.80
Open Access Status
Volume 107
Issue 14
Start page 1906
End page 1911
Total pages 6
Place of publication Baltimore, MD, United States
Publisher Lippincott, Williams & Wilkins
Language eng
Subject 111401 Foetal Development and Medicine
111402 Obstetrics and Gynaecology
1114 Paediatrics and Reproductive Medicine
Abstract Background-In twin-twin transfusion syndrome (TTTS), the donor and recipient fetus are exposed to differing volume loads and show discordant intertwin vascular compliance in childhood despite identical genotype. We hypothesized that discordance is prevented by intrauterine endoscopic laser ablation of placental anastomoses, which abolishes intertwin transfusion. We tested this by examining pulse wave velocity (PWV) in brachial arteries of twin survivors of TTTS treated with and without laser therapy.
Formatted abstract
Background:
In twin-twin transfusion syndrome (TTTS), the donor and recipient fetus are exposed to differing volume loads and show discordant intertwin vascular compliance in childhood despite identical genotype. We hypothesized that discordance is prevented by intrauterine endoscopic laser ablation of placental anastomoses, which abolishes intertwin transfusion. We tested this by examining pulse wave velocity (PWV) in brachial arteries of twin survivors of TTTS treated with and without laser therapy.

Methods and Results
:
One hundred children (50 twin pairs, 27 with TTTS) were studied. Group 1 comprised 14 monochorionic (MC) twin pairs with TTTS treated symptomatically; group 2 comprised 13 MC twin pairs with TTTS treated by laser. The control groups comprised 12 MC twin pairs without TTTS (group 3) and 11 dichorionic twin pairs (group 4). Fetal cardiovascular data, predictive factors for, and duration of TTTS and cord blood were collected prospectively. We measured blood pressure and PWV photoplethysmographically at a median corrected postnatal age of 11 months (range, 1 week to 66 months). Both TTTS groups showed marked intertwin PWV discordance, unlike MCDA control subjects. The PWV discordance seen in laser treated twin pairs resembled that of dichorionic control subjects (heavier individual with higher PWV), whereas group 1 showed the opposite (negative) intertwin discordance (ANOVA F (1,45)=4.5, P=0.04). No significant differences in blood pressure or intrauterine growth were observed between TTTS groups.

Conclusions
:
Vascular programming is evident in monozygotic twins with intertwin transfusion and is altered but not abolished by intrauterine therapy to resemble that seen in

Keyword Vasculature
Elasticity
Arteries
Lasers
Pregnancy
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status Non-UQ

Document type: Journal Article
Sub-type: Article (original research)
Collections: Faculty of Health and Behavioural Sciences -- Publications
Excellence in Research Australia (ERA) - Collection
 
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Created: Thu, 19 Mar 2009, 23:12:33 EST by Mary-Anne Marrington on behalf of Faculty Of Health Sciences