Habli Mounira, Michelfelder Erik, Livingston Jeffrey, Harmon Jeffrey, Lim Foong Yen, Polzin William, Crombleholme Timothy
Fetal Care Center of Cincinnati, Cincinnati Children's Hospital, Cincinnati, OH 45229-3039, USA.
Am J Obstet Gynecol. 2008 Oct;199(4):412.e1-6. doi: 10.1016/j.ajog.2008.06.067. Epub 2008 Aug 22.
This study evaluated the acute effects of selective fetoscopic laser photocoagulation (SFLP) on recipient cardiovascular function in a twin-twin transfusion syndrome (TTTS) pregnancy.
This was a retrospective chart review of echocardiographic data in TTTS including right (RV) and left (LV) ventricular Doppler myocardial performance index (MPI); LV and RV end diastolic wall thickness; and umbilical artery (UA), vein (UV), and ductus venosus (DV) Dopplers. The primary outcome measures were improved MPI defined as greater than 10% interval decrease in left and/or right MPI. Data were analyzed by Student t test and Fisher's exact test.
Sixty-five patients met inclusion criteria. SFLP results in a significant improvement in UV and DV Doppler and an increase in both RV and LV wall thickness. A 10% or greater improvement in recipient LV MPI after SFLP is associated with improved recipient survival as compared with unimproved LV MPI (100% vs 86.1%, P = .05).
Improved recipient myocardial performance index after SFLP is associated with improvement in recipient survival.
本研究评估了选择性胎儿镜激光凝固术（SFLP）对双胎输血综合征（TTTS）妊娠中受血者心血管功能的急性影响。
这是一项对TTTS患者超声心动图数据的回顾性图表审查，包括右心室（RV）和左心室（LV）的多普勒心肌性能指数（MPI）；左心室和右心室舒张末期壁厚度；以及脐动脉（UA）、脐静脉（UV）和静脉导管（DV）的多普勒检查。主要结局指标是MPI改善，定义为左和/或右MPI间期降低超过10%。数据采用Student t检验和Fisher精确检验进行分析。
65例患者符合纳入标准。SFLP可使UV和DV多普勒检查结果显著改善，右心室和左心室壁厚度增加。与未改善的左心室MPI相比，SFLP后受血者左心室MPI改善10%或更多与受血者生存率提高相关（100%对86.1%，P = .05）。
SFLP后受血者心肌性能指数的改善与受血者生存率的提高相关。
