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Twin-to-twin transfusion syndrome: Perinatal outcome and recipient heart disease according to treatment strategy

Authors

  • Catherine Barrea,

    Corresponding author
    1. Fetal Medicine, Department of Obstetrics and Gynaecology, Cliniques universitaires Saint-Luc (UCL), Brussels, Belgium
    • Paediatric Cardiology, Cliniques universitaires Saint-Luc (UCL), Brussels, Belgium
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  • Christian Debauche,

    1. Neonatology, Department of Paediatrics, Cliniques universitaires Saint-Luc (UCL), Brussels, Belgium
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  • Olivia Williams,

    1. Neonatology, Department of Paediatrics, Cliniques universitaires Saint-Luc (UCL), Brussels, Belgium
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  • Stéphanie Jasienski,

    1. Neonatology, Department of Paediatrics, Cliniques universitaires Saint-Luc (UCL), Brussels, Belgium
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  • Patricia Steenhaut,

    1. Fetal Medicine, Department of Obstetrics and Gynaecology, Cliniques universitaires Saint-Luc (UCL), Brussels, Belgium
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  • Thierry Sluysmans,

    1. Paediatric Cardiology, Cliniques universitaires Saint-Luc (UCL), Brussels, Belgium
    2. Fetal Medicine, Department of Obstetrics and Gynaecology, Cliniques universitaires Saint-Luc (UCL), Brussels, Belgium
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  • Pierre Bernard,

    1. Fetal Medicine, Department of Obstetrics and Gynaecology, Cliniques universitaires Saint-Luc (UCL), Brussels, Belgium
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  • Corinne Hubinont

    1. Fetal Medicine, Department of Obstetrics and Gynaecology, Cliniques universitaires Saint-Luc (UCL), Brussels, Belgium
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  • Conflict of interest statement: The authors declare that they have no conflict of interest.
  • 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.

Correspondence: Dr Catherine Barrea, Paediatric and Fetal Cardiology, Cliniques universitaires Saint-Luc, 10 Avenue Hippocrate, 1200 Brussels, Belgium. Fax: +32 2764 89 11; email: catherine.barrea@uclouvain.be

Abstract

Aim

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).

Methods

We retrospectively reviewed 81 consecutive cases of twin-to-twin transfusion syndrome diagnosed before 28 weeks between 1993 and 2007.

Results

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.

Conclusions

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.

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