Long-term cardiac follow-up of severe twin-to-twin transfusion syndrome after intrauterine laser coagulation

Ulrike Herberg ^1*, Wolf Gross ¹, Peter Bartmann ², Corinna S Banek ², Kurt Hecher ³ and Johannes Breuer ¹

¹ Division of Pediatric Cardiology, University of Bonn, Germany
² Division of Neonatology, University of Bonn, Germany
³ Dept. of Obstetrics and Fetal Medicine, University Clinic Hamburg-Eppendorf, Germany

^* To whom correspondence should be addressed. E-mail: ulrike.herberg{at}ukb.uni-bonn.de.

Accepted 17 March 2005

Abstract

Objective: To assess long-term changes on cardiac morphology and function in survivors of severe twin-to-twin transfusion syndrome (TTTS) following intrauterine laser coagulation of placental anastomoses.

Design: Prospective follow-up of fetuses with severe TTTS, treated by laser coagulation of intrauterine placental anastomoses. Fetal echocardiography and Doppler studies of feto-placental haemodynamics were performed at the time of laser coagulation (median gestational age of 21.7 weeks). Postnatal cardiac follow-up included a detailed echocardiographic study of systolic and diastolic cardiac function at a median age of 21.1 months.

Setting: Unit for paediatric cardiology Patients: 89 survivors from 73 consecutive pregnancies with severe TTTS.

Results: Prior to laser therapy, 54.9% of the recipient twins revealed typical signs of cardiac dysfunction due to volume overload and 23.7% of the donors had absent or reversed enddiastolic flow in the umbilical artery. 87.6% of the survivors (34/38 donors, 44/51 recipients) showed normal echocardiography. The prevalence of congenital heart disease (CHD) and particularly of pulmonary stenosis (PS), which was only recorded in recipients, was increased in comparison to the general population (CHD: 11.2% v. 0.3%; PS: 7.8% v. 0.03%). There was no correlation between findings before laser therapy and the development of structural heart disease.

Conclusions: Inspite of the high rate and severity of prenatal cardiac overload in recipients, normalisation occurs in the majority of cases after laser therapy. However, given the increased prevalence of congenital heart disease, and in particular pulmonary stenosis, intrauterine and postnatal follow-up is warranted.

Keywords: congenital heart disease, long-term follow-up, prenatal diagnosis, pulmonary stenosis, twin-twin transfusion syndrome

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