Postnatal Myocardial Function in Monochorionic Diamniotic Twins with Twin-to-Twin Transfusion Syndrome following Selective Laser Photocoagulation of the Communicating Placental Vessels

被引：7
作者：
Breatnach, Colm R. [1 ]
Bussmann, Neidin [1 ]
Levy, Phillip T. [5 ,6 ]
Vincent, Danielle F. [1 ]
Malone, Fergal D. [2 ]
McCallion, Naomi [1 ,3 ]
Franklin, Orla [4 ]
EL-Khuffash, Afif [1 ]
机构：
[1] Rotunda Hosp, Dept Neonatol, Dublin, Ireland
[2] Royal Coll Surgeons Ireland, Dept Obstet & Gynecol, Dublin, Ireland
[3] Royal Coll Surgeons Ireland, Dept Pediat, Sch Med, Dublin, Ireland
[4] Our Ladys Childrens Hosp Crumlin, Dept Cardiol, Dublin, Ireland
[5] Boston Childrens Hosp, Div Newborn Med, Boston, MA USA
[6] Harvard Med Sch, Dept Pediat, Boston, MA 02115 USA
来源：
JOURNAL OF THE AMERICAN SOCIETY OF ECHOCARDIOGRAPHY | 2019年 / 32卷 / 06期
关键词：
Twin-to-twin transfusion syndrome; Deformation; Speckle-tracking echocardiography; Preterm infant; SPECKLE-TRACKING ECHOCARDIOGRAPHY; OUTFLOW TRACT OBSTRUCTION; CARDIAC-FUNCTION; STRAIN-RATE; VENTRICULAR FUNCTION; PRETERM INFANTS; DEFORMATION; RECIPIENT; PERFORMANCE; CHILDREN;
D O I：
10.1016/j.echo.2019.02.004
中图分类号：
R5 [内科学];
学科分类号：
1002 ; 100201 ;
摘要：
Background: Monochorionic diamniotic (MCDA) twins are at risk for developing twin-to-twin transfusion syndrome (TTTS) throughout pregnancy. This may lead to myocardial dysfunction in the recipient and/or donor twin that persists beyond delivery. Selective laser photocoagulation of the communicating placental vessels (SLPCV) attempts to mitigate the cardiovascular outcomes. The objective of this study was to characterize early postnatal myocardial performance in MCDA twins with TTTS with and without SLPCV. Methods: A prospective study was performed of four MCDA twin groups: (1) uncomplicated MCDA twins, (2) MCDA twins with selective fetal growth restriction, (3) MCDA twins with TTTS following SLPCV (TTTS with SLPCV), and (4) MCDA twins with TTTS who did not undergo SLPCV (TTTS without SLPCV). Fifty-four twin pairs were enrolled: 23 uncomplicated MCDA twin pairs, 15 pairs with selective fetal growth restriction, seven TTTS pairs with SLPCV, and seven TTTS pairs without SLPCV. In each group, twin pairs were divided by birth weight into donor (smaller) and recipient (larger) and compared. Echocardiography was performed on day 1, day 2, and between days 5 and 7 of age, and myocardial performance was characterized by speckle-tracking echocardiography-derived left ventricular and right ventricular longitudinal strain (LS) and systolic strain rate (LSR). Longitudinal strain and longitudinal systolic strain rate are expressed as absolute values. Results: Compared with all recipient groups, recipient TTTS without SLPCV infants had lower left ventricular LS (1663% vs 22%-24%, P < .01) and right ventricular LS (15 +/- 5% vs 21%-24%, P < .01) on day 1 that persisted throughout the first week of age. Left ventricular LSR (1.7 +/- 0.3 vs 2.3 +/- 0.3 sec(-1), P < .05) and right ventricular LSR (1.5 +/- 0.4 vs 1.7 +/- 0.5 sec(-1), P < .05) were both lower in the recipient compared with the donor twin in the TTTS without SLPCV group. LS and LSR measurements were similar among all four donor twin groups. Conclusions: Biventricular performance is diminished in recipient MCDA twins with TTTS who are not treated with SLPCV, highlighting the need for close monitoring of their hemodynamic status during the early neonatal period.
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收藏
页码：774 / +
页数：12
相关论文
共 42 条
[1]   Twenty-Five Years of Fetoscopic Laser Coagulation in Twin-Twin Transfusion Syndrome: A Systematic Review [J].
Akkermans, Joost ;
Peeters, Suzanne H. P. ;
Klumper, Frans J. ;
Lopriore, Enrico ;
Middeldorp, Johanna M. ;
Oepkes, Dick .
FETAL DIAGNOSIS AND THERAPY, 2015, 38 (04) :241-253
[2]   Strain Rate in Children and Young Piglets Mirrors Changes in Contractility and Demonstrates a Force-Frequency Relationship [J].
Alvarez, Silvia V. ;
Fortin-Pellerin, Etienne ;
Alhabdan, Mohammed ;
Lomelin, Jesus S. ;
Kantoch, Michal ;
Atallah, Joseph ;
Hornberger, Lisa K. ;
Coe, James Y. ;
Cheung, Po-Yin ;
Tham, Edythe B. ;
Mah, Kandice ;
Lin, Lily ;
Mills, Lindsay ;
Khoo, Nee S. .
JOURNAL OF THE AMERICAN SOCIETY OF ECHOCARDIOGRAPHY, 2017, 30 (08) :797-806
[3]   Impact of preterm birth on the developing myocardium of the neonate [J].
Bensley, Jonathan G. ;
Moore, Lynette ;
De Matteo, Robert ;
Harding, Richard ;
Black, Mary Jane .
PEDIATRIC RESEARCH, 2018, 83 (04) :880-888
[4]   Relevance of measuring diastolic time intervals in the ductus venosus during the early stages of twin-twin transfusion syndrome [J].
Bensouda, B. ;
Fouron, J. -C. ;
Raboisson, M. -J. ;
Lamoureux, J. ;
Lachance, C. ;
Leduc, L. .
ULTRASOUND IN OBSTETRICS & GYNECOLOGY, 2007, 30 (07) :983-987
[5]   Strain Rate and Its Positive Force-Frequency Relationship: Further Evidence from a Premature Infant Cohort [J].
Breatnach, Colm R. ;
Levy, Phil T. ;
Franklin, Orla ;
EL-Khuffash, Afif .
JOURNAL OF THE AMERICAN SOCIETY OF ECHOCARDIOGRAPHY, 2017, 30 (10) :1045-1046
[6]   Novel Echocardiography Methods in the Functional Assessment of the Newborn Heart [J].
Breatnach, Colm R. ;
Levy, Philip T. ;
James, Adam T. ;
Franklin, Orla ;
El-Khuffash, Afif .
NEONATOLOGY, 2016, 110 (04) :248-260
[7]  
Cox SM, 2001, INT J GYNECOL OBSTET, V72, P85
[8]   Fetal Cardiac Function: Technical Considerations and Potential Research and Clinical Applications [J].
Crispi, Fatima ;
Gratacos, Eduard .
FETAL DIAGNOSIS AND THERAPY, 2012, 32 (1-2) :47-64
[9]   Neonatologist-performed functional echocardiography in the neonatal intensive care unit [J].
El-Khuffash, Afif F. ;
McNamara, Patrick J. .
SEMINARS IN FETAL & NEONATAL MEDICINE, 2011, 16 (01) :50-60
[10]   Right ventricular outflow tract obstruction in complicated monochorionic twin pregnancy [J].
Eschbach, S. J. ;
Boons, L. S. T. M. ;
Van Zwet, E. ;
Middeldorp, J. M. ;
Klumper, F. J. C. M. ;
Lopriore, E. ;
Teunissen, A. K. K. ;
Rijlaarsdam, M. E. ;
Oepkes, D. ;
Ten Harkel, A. D. J. ;
Haak, M. C. .
ULTRASOUND IN OBSTETRICS & GYNECOLOGY, 2017, 49 (06) :737-743
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