Gardiner Helena M, Taylor Myles J O, Karatza Ageliki, Vanderheyden Tina, Huber Agnes, Greenwald Stephen E, Fisk Nicholas M, Hecher Kurt
Department of Pediatric Cardiology, Royal Brompton Hospital, London, UK.
Circulation. 2003 Apr 15;107(14):1906-11. doi: 10.1161/01.CIR.0000060543.64250.80. Epub 2003 Mar 17.
In twin-twin transfusion syndrome (TTTS), the donor and recipient fetus are exposed to differing volume loads and show discordant intertwin vascular compliance in childhood despite identical genotype. We hypothesized that discordance is prevented by intrauterine endoscopic laser ablation of placental anastomoses, which abolishes intertwin transfusion. We tested this by examining pulse wave velocity (PWV) in brachial arteries of twin survivors of TTTS treated with and without laser therapy.
One hundred children (50 twin pairs, 27 with TTTS) were studied. Group 1 comprised 14 monochorionic (MC) twin pairs with TTTS treated symptomatically; group 2 comprised 13 MC twin pairs with TTTS treated by laser. The control groups comprised 12 MC twin pairs without TTTS (group 3) and 11 dichorionic twin pairs (group 4). Fetal cardiovascular data, predictive factors for, and duration of TTTS and cord blood were collected prospectively. We measured blood pressure and PWV photoplethysmographically at a median corrected postnatal age of 11 months (range, 1 week to 66 months). Both TTTS groups showed marked intertwin PWV discordance, unlike MCDA control subjects. The PWV discordance seen in laser treated twin pairs resembled that of dichorionic control subjects (heavier individual with higher PWV), whereas group 1 showed the opposite (negative) intertwin discordance (ANOVA F (1,45)=4.5, P=0.04). No significant differences in blood pressure or intrauterine growth were observed between TTTS groups.
Vascular programming is evident in monozygotic twins with intertwin transfusion and is altered but not abolished by intrauterine therapy to resemble that seen in dichorionic twins.
在双胎输血综合征（TTTS）中，供血胎儿和受血胎儿承受不同的容量负荷，尽管基因型相同，但在儿童期双胎间血管顺应性存在差异。我们推测，通过宫内内镜激光消融胎盘吻合支可预防这种差异，因为这会消除双胎间输血。我们通过检查接受和未接受激光治疗的TTTS双胎幸存者肱动脉的脉搏波速度（PWV）来验证这一推测。
研究了100名儿童（50对双胞胎，其中27对患有TTTS）。第1组包括14对接受对症治疗的单绒毛膜（MC）双胎TTTS；第2组包括13对接受激光治疗的MC双胎TTTS。对照组包括12对无TTTS的MC双胎（第3组）和11对双绒毛膜双胎（第4组）。前瞻性收集胎儿心血管数据、TTTS的预测因素、病程及脐血情况。我们在出生后校正年龄中位数为11个月（范围1周至66个月）时，通过光电容积描记法测量血压和PWV。与MCDA对照组不同，两个TTTS组均显示出明显的双胎间PWV差异。接受激光治疗的双胎对中观察到的PWV差异类似于双绒毛膜对照组（体重较重者PWV较高），而第1组显示出相反的（负性）双胎间差异（方差分析F(1,45)=4.5，P=0.04）。TTTS组之间在血压或宫内生长方面未观察到显著差异。
血管编程在存在双胎间输血的单卵双胎中很明显，宫内治疗可改变但不能消除这种情况，使其类似于双绒毛膜双胎中的情况。
