Conflict of interest statement: The authors declare that they have no conflict of interest.
Twin-to-twin transfusion syndrome: Perinatal outcome and recipient heart disease according to treatment strategy
Article first published online: 21 DEC 2012
© 2012 The Authors. Journal of Paediatrics and Child Health © 2012 Paediatrics and Child Health Division (Royal Australasian College of Physicians)
Journal of Paediatrics and Child Health
Volume 49, Issue 1, pages E28–E34, January 2013
How to Cite
Barrea, C., Debauche, C., Williams, O., Jasienski, S., Steenhaut, P., Sluysmans, T., Bernard, P. and Hubinont, C. (2013), Twin-to-twin transfusion syndrome: Perinatal outcome and recipient heart disease according to treatment strategy. Journal of Paediatrics and Child Health, 49: E28–E34. doi: 10.1111/jpc.12060
Both first authors (CB and CD) participated equally in the conception and design of the work, the interpretation of data and the drafting of the manuscript. CB performed the data collection and data analysis.
- Issue published online: 16 JAN 2013
- Article first published online: 21 DEC 2012
- Manuscript Accepted: 1 MAY 2012
- heart function;
- selective feticide;
- twin-to-twin transfusion syndrome
The aims of the study were to compare perinatal outcome and assess recipient cardiac disease according to treatment strategy (amnioreduction (AR), laser or selective feticide).
We retrospectively reviewed 81 consecutive cases of twin-to-twin transfusion syndrome diagnosed before 28 weeks between 1993 and 2007.
Although fetuses treated by laser were younger at diagnosis (median 20.4 vs. 22.4 weeks, P = 0.01), they were significantly older at birth (median 33.6 vs. 28.5 weeks, P = 0.004) than those treated by AR. Neonatal morbidity was globally lower after laser than AR, and cardiac insufficiency tended to be less frequent (31% vs. 57%, P = 0.09). There was a trend towards increased perinatal survival after laser treatment (68% vs. 49%, P = 0.1). Heart failure was the cause of death in half (23/46) of the recipients. Fetal heart failure leading to death was 2.7 times more frequent after AR than after laser (n = 11 vs. n = 4), and all four neonatal cardiac deaths occurred after AR. Compared with laser, selective feticide did not further improve the outcome.
Heart failure was an important cause of perinatal morbidity and death. However, laser therapy resulted in a longer diagnosis–delivery interval and lower global neonatal morbidity than AR, with a trend towards increased perinatal survival. Improved outcome after laser treatment compared with AR might be related to its impact on recipient heart disease.