Shah Amy D, Border William L, Crombleholme Timothy M, Michelfelder Erik C
Fetal Care Center of Cincinnati, Divisions of Pediatric Cardiology, General, Thoracic, and Fetal Surgery, Cincinnati Children's Hospital and University of Cincinnati College of Medicine, Cincinnati, Ohio, USA.
J Am Soc Echocardiogr. 2008 Oct;21(10):1105-8. doi: 10.1016/j.echo.2008.05.004. Epub 2008 Jun 16.
The aim of this study was to assess the relationship between cardiomyopathy and recipient twin (RT) outcome in twin-twin transfusion syndrome (TTTS).
Fetal echocardiography and outcomes data in 62 consecutive pregnancies with TTTS were reviewed. The primary outcome was neonatal RT survival. The severity of RT cardiomyopathy at presentation was assessed by the cardiovascular profile score (CVPS). RT outcomes and odds of survival were compared between groups stratified by CVPS.
Overall neonatal survival for all fetuses was 61% (76 of 124). RT survival was 58% (36 of 62). Grouped by CVPS, RT survival was greater (50%) for those with CVPS > or = 9 and even higher (74%) for CVPS of 10. Among the components of the CVPS, atrioventricular valve regurgitation was associated with negative RT outcome. Other factors at presentation were not predictive of RT outcome.
A normal CVPS in the RT in TTTS is predictive of improved survival compared with an abnormal CVPS, even in RTs with minor deductions. Standard clinical staging did not predict outcome. Cardiac assessment by CVPS may improve clinical decision making and the timing of fetal interventions.
本研究旨在评估双胎输血综合征（TTTS）中，心肌病与受血儿（RT）结局之间的关系。
回顾了62例连续妊娠合并TTTS的胎儿超声心动图及结局数据。主要结局为新生儿期受血儿存活情况。通过心血管轮廓评分（CVPS）评估受血儿心肌病在初次检查时的严重程度。比较根据CVPS分层的各组受血儿结局及存活几率。
所有胎儿的总体新生儿存活率为61%（124例中的76例）。受血儿存活率为58%（62例中的36例）。根据CVPS分组，CVPS≥9的受血儿存活率更高（50%），CVPS为10时甚至更高（74%）。在CVPS的各项组成部分中，房室瓣反流与受血儿不良结局相关。初次检查时的其他因素无法预测受血儿结局。
与异常CVPS相比，TTTS中受血儿的正常CVPS可预测存活率提高，即使是CVPS稍有扣分的受血儿。标准临床分期无法预测结局。通过CVPS进行心脏评估可能会改善临床决策及胎儿干预时机。
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