选择性胎儿镜激光凝固术对双胎输血综合征受血儿心功能的急性影响
Acute effects of selective fetoscopic laser photocoagulation on recipient cardiac function in twin-twin transfusion syndrome.
作者信息
Habli Mounira, Michelfelder Erik, Livingston Jeffrey, Harmon Jeffrey, Lim Foong Yen, Polzin William, Crombleholme Timothy
机构信息
Fetal Care Center of Cincinnati, Cincinnati Children's Hospital, Cincinnati, OH 45229-3039, USA.
出版信息
Am J Obstet Gynecol. 2008 Oct;199(4):412.e1-6. doi: 10.1016/j.ajog.2008.06.067. Epub 2008 Aug 22.
OBJECTIVE
This study evaluated the acute effects of selective fetoscopic laser photocoagulation (SFLP) on recipient cardiovascular function in a twin-twin transfusion syndrome (TTTS) pregnancy.
STUDY DESIGN
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.
RESULTS
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).
CONCLUSION
Improved recipient myocardial performance index after SFLP is associated with improvement in recipient survival.
目的
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。
研究设计
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。
结果
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）。
结论
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。
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