Estimated combined cardiac output and laser therapy for twin–twin transfusion syndrome

Shiraz A. Maskatia, Rodrigo Ruano, Alireza A. Shamshirsaz, Pouya Javadian, Joshua A. Kailin, Michael A. Belfort, Carolyn A. Altman, Nancy A. Ayres

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Introduction: Twin–twin transfusion syndrome (TTTS) is the major cause for fetal demise in monochorionic diamniotic pregnancies. Estimated combined cardiac output (CCO) has not been studied in this setting. The primary aims of this study were to compare CCO in twin donor and recipient fetuses and assess differences in CCO before and after laser coagulation therapy. A secondary aim was to evaluate the relationship of CCO with perinatal mortality, defined as intrauterine or neonatal mortality (≤30 days of age) in fetuses that underwent laser coagulation therapy. Methods: We performed a retrospective review of fetuses with TTTS who received echocardiograms prior to laser therapy. Prelaser echocardiograms were performed in 66 fetuses, of which 45 (21 donor and 24 recipient) survived to the postlaser echocardiogram. Results: Donor CCO increased from a mean of 487±137 mL/min/kg prelaser to 592±128 mL/min/kg postlaser (P=.025). There was no significant change in mean recipient CCO from prelaser 551±165 mL/min/kg to postlaser 575±112 mL/min/kg (P=.564). In recipient fetuses, higher prelaser CCO correlated with increasing Quintero stage (P=.010) and perinatal mortality (P=.003). Thirty-day postnatal outcome data were available for 38 fetuses, of whom 34 (89%) survived. Amongst survivors, 25 (74%) experienced an increase in CCO, while 9 (26%) experienced a decrease in CCO (P=.010). Donor fetuses had higher CCO after laser therapy. Conclusions: Higher prelaser CCO in recipient fetuses may indicate more advanced disease. Fetuses who exhibit a decrease in CCO after therapy laser may be at higher risk for perinatal mortality.

Original languageEnglish (US)
Pages (from-to)1563-1570
Number of pages8
JournalEchocardiography
Volume33
Issue number10
DOIs
StatePublished - Oct 1 2016
Externally publishedYes

Fingerprint

Laser Therapy
Cardiac Output
Fetus
Perinatal Mortality
Tissue Donors
Laser Coagulation
High Cardiac Output
Fetal Death
Infant Mortality
Survivors
Pregnancy

Keywords

  • estimated cardiac output
  • fetal echocardiography
  • fetal intervention
  • twin gestation
  • twin–twin transfusion syndrome

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Maskatia, S. A., Ruano, R., Shamshirsaz, A. A., Javadian, P., Kailin, J. A., Belfort, M. A., ... Ayres, N. A. (2016). Estimated combined cardiac output and laser therapy for twin–twin transfusion syndrome. Echocardiography, 33(10), 1563-1570. https://doi.org/10.1111/echo.13304

Estimated combined cardiac output and laser therapy for twin–twin transfusion syndrome. / Maskatia, Shiraz A.; Ruano, Rodrigo; Shamshirsaz, Alireza A.; Javadian, Pouya; Kailin, Joshua A.; Belfort, Michael A.; Altman, Carolyn A.; Ayres, Nancy A.

In: Echocardiography, Vol. 33, No. 10, 01.10.2016, p. 1563-1570.

Research output: Contribution to journalArticle

Maskatia, SA, Ruano, R, Shamshirsaz, AA, Javadian, P, Kailin, JA, Belfort, MA, Altman, CA & Ayres, NA 2016, 'Estimated combined cardiac output and laser therapy for twin–twin transfusion syndrome', Echocardiography, vol. 33, no. 10, pp. 1563-1570. https://doi.org/10.1111/echo.13304
Maskatia SA, Ruano R, Shamshirsaz AA, Javadian P, Kailin JA, Belfort MA et al. Estimated combined cardiac output and laser therapy for twin–twin transfusion syndrome. Echocardiography. 2016 Oct 1;33(10):1563-1570. https://doi.org/10.1111/echo.13304
Maskatia, Shiraz A. ; Ruano, Rodrigo ; Shamshirsaz, Alireza A. ; Javadian, Pouya ; Kailin, Joshua A. ; Belfort, Michael A. ; Altman, Carolyn A. ; Ayres, Nancy A. / Estimated combined cardiac output and laser therapy for twin–twin transfusion syndrome. In: Echocardiography. 2016 ; Vol. 33, No. 10. pp. 1563-1570.
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abstract = "Introduction: Twin–twin transfusion syndrome (TTTS) is the major cause for fetal demise in monochorionic diamniotic pregnancies. Estimated combined cardiac output (CCO) has not been studied in this setting. The primary aims of this study were to compare CCO in twin donor and recipient fetuses and assess differences in CCO before and after laser coagulation therapy. A secondary aim was to evaluate the relationship of CCO with perinatal mortality, defined as intrauterine or neonatal mortality (≤30 days of age) in fetuses that underwent laser coagulation therapy. Methods: We performed a retrospective review of fetuses with TTTS who received echocardiograms prior to laser therapy. Prelaser echocardiograms were performed in 66 fetuses, of which 45 (21 donor and 24 recipient) survived to the postlaser echocardiogram. Results: Donor CCO increased from a mean of 487±137 mL/min/kg prelaser to 592±128 mL/min/kg postlaser (P=.025). There was no significant change in mean recipient CCO from prelaser 551±165 mL/min/kg to postlaser 575±112 mL/min/kg (P=.564). In recipient fetuses, higher prelaser CCO correlated with increasing Quintero stage (P=.010) and perinatal mortality (P=.003). Thirty-day postnatal outcome data were available for 38 fetuses, of whom 34 (89{\%}) survived. Amongst survivors, 25 (74{\%}) experienced an increase in CCO, while 9 (26{\%}) experienced a decrease in CCO (P=.010). Donor fetuses had higher CCO after laser therapy. Conclusions: Higher prelaser CCO in recipient fetuses may indicate more advanced disease. Fetuses who exhibit a decrease in CCO after therapy laser may be at higher risk for perinatal mortality.",
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AU - Maskatia, Shiraz A.

AU - Ruano, Rodrigo

AU - Shamshirsaz, Alireza A.

AU - Javadian, Pouya

AU - Kailin, Joshua A.

AU - Belfort, Michael A.

AU - Altman, Carolyn A.

AU - Ayres, Nancy A.

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N2 - Introduction: Twin–twin transfusion syndrome (TTTS) is the major cause for fetal demise in monochorionic diamniotic pregnancies. Estimated combined cardiac output (CCO) has not been studied in this setting. The primary aims of this study were to compare CCO in twin donor and recipient fetuses and assess differences in CCO before and after laser coagulation therapy. A secondary aim was to evaluate the relationship of CCO with perinatal mortality, defined as intrauterine or neonatal mortality (≤30 days of age) in fetuses that underwent laser coagulation therapy. Methods: We performed a retrospective review of fetuses with TTTS who received echocardiograms prior to laser therapy. Prelaser echocardiograms were performed in 66 fetuses, of which 45 (21 donor and 24 recipient) survived to the postlaser echocardiogram. Results: Donor CCO increased from a mean of 487±137 mL/min/kg prelaser to 592±128 mL/min/kg postlaser (P=.025). There was no significant change in mean recipient CCO from prelaser 551±165 mL/min/kg to postlaser 575±112 mL/min/kg (P=.564). In recipient fetuses, higher prelaser CCO correlated with increasing Quintero stage (P=.010) and perinatal mortality (P=.003). Thirty-day postnatal outcome data were available for 38 fetuses, of whom 34 (89%) survived. Amongst survivors, 25 (74%) experienced an increase in CCO, while 9 (26%) experienced a decrease in CCO (P=.010). Donor fetuses had higher CCO after laser therapy. Conclusions: Higher prelaser CCO in recipient fetuses may indicate more advanced disease. Fetuses who exhibit a decrease in CCO after therapy laser may be at higher risk for perinatal mortality.

AB - Introduction: Twin–twin transfusion syndrome (TTTS) is the major cause for fetal demise in monochorionic diamniotic pregnancies. Estimated combined cardiac output (CCO) has not been studied in this setting. The primary aims of this study were to compare CCO in twin donor and recipient fetuses and assess differences in CCO before and after laser coagulation therapy. A secondary aim was to evaluate the relationship of CCO with perinatal mortality, defined as intrauterine or neonatal mortality (≤30 days of age) in fetuses that underwent laser coagulation therapy. Methods: We performed a retrospective review of fetuses with TTTS who received echocardiograms prior to laser therapy. Prelaser echocardiograms were performed in 66 fetuses, of which 45 (21 donor and 24 recipient) survived to the postlaser echocardiogram. Results: Donor CCO increased from a mean of 487±137 mL/min/kg prelaser to 592±128 mL/min/kg postlaser (P=.025). There was no significant change in mean recipient CCO from prelaser 551±165 mL/min/kg to postlaser 575±112 mL/min/kg (P=.564). In recipient fetuses, higher prelaser CCO correlated with increasing Quintero stage (P=.010) and perinatal mortality (P=.003). Thirty-day postnatal outcome data were available for 38 fetuses, of whom 34 (89%) survived. Amongst survivors, 25 (74%) experienced an increase in CCO, while 9 (26%) experienced a decrease in CCO (P=.010). Donor fetuses had higher CCO after laser therapy. Conclusions: Higher prelaser CCO in recipient fetuses may indicate more advanced disease. Fetuses who exhibit a decrease in CCO after therapy laser may be at higher risk for perinatal mortality.

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KW - fetal intervention

KW - twin gestation

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