Gardiner H M, Matsui H, Roughton M, Greenwald S E, Diemert A, Taylor M J O, Hecher K
Faculty of Medicine, Imperial College, Queen Charlotte's and Chelsea Hospital, London, UK; Royal Brompton NHS Foundation Trust Hospital, London, UK.
Ultrasound Obstet Gynecol. 2014 Jun;43(6):652-7. doi: 10.1002/uog.13279.
To compare cardiac function at 10 years of age in four groups of monochorionic diamniotic (MCDA) twin pairs: uncomplicated MCDA twins (n = 6) (Group 1); twins that had had twin-twin transfusion syndrome (TTTS) managed by amnioreduction (TTTS-amnio, n = 9) (Group 2) or laser photocoagulation (TTTS-laser, n = 10) (Group 3); and dichorionic diamniotic controls (DCDA, n = 6) (Group 4).
Echocardiograms optimizing apical four-chamber and short-axis left ventricular views were stored for offline speckle-tracking analysis, blinded to twin type. Myocardial long-axis shortening and lengthening velocities were measured using pulsed Doppler ultrasound at the cardiac base. M-mode measurements of fractional shortening (short axis) and maximal excursion of the atrioventricular annulus (four-chamber) were recorded. Syngo Vector Velocity Imaging software tracked left ventricular myocardial motion offline to produce free wall strain, strain rate and rotation. Intertwin pair and group differences were investigated using ANOVA.
Cardiac measurements were within the normal ranges for 10-year-olds. No significant within-twin-pair and intergroup differences were found in current size, heart rates, strain or strain rate. Compared to DCDA controls, TTTS twins showed less cardiac rotation (TTTS-laser, P < 0.001 and TTTS-amnio, P = 0.054) with significant intertwin reduction in the ex-recipient (TTTS-amnio, P = 0.006) and larger MCDA twins (P = 0.027) compared with their cotwins. A similar pattern was seen in left ventricular early diastolic mitral valve tissue velocity (MVE') in all monochorionic groups, but only achieving significance in TTTS-amnio twins (P = 0.037). Intrapair differences in rotation and MVE' were significantly different following treatment at Quintero stages III or IV.
Within-twin-pair patterns of left ventricular rotation and diastolic function differ at 10 years of age in ex-recipients of TTTS twins treated with amnioreduction compared with those treated by laser photocoagulation and controls. .
比较四组单绒毛膜双羊膜囊（MCDA）双胎在10岁时的心脏功能：无并发症的MCDA双胎（n = 6）（第1组）；接受羊水减量术治疗双胎输血综合征（TTTS）的双胎（TTTS - amnio，n = 9）（第2组）或激光光凝治疗的双胎（TTTS - laser，n = 10）（第3组）；以及双绒毛膜双羊膜囊对照（DCDA，n = 6）（第4组）。
存储优化心尖四腔心和左心室短轴视图的超声心动图，用于离线斑点追踪分析，对双胎类型进行盲法评估。使用心脏基部的脉冲多普勒超声测量心肌长轴缩短和延长速度。记录短轴方向的缩短分数和四腔心方向房室环最大偏移的M型测量值。Syngo Vector Velocity Imaging软件对左心室心肌运动进行离线追踪，以生成游离壁应变、应变率和旋转。使用方差分析研究双胎对间和组间差异。
心脏测量值在10岁儿童的正常范围内。在当前大小、心率、应变或应变率方面，未发现双胎对内和组间存在显著差异。与DCDA对照相比，TTTS双胎显示出较少的心脏旋转（TTTS - laser，P < 0.001；TTTS - amnio，P = 0.054），与同卵双胎相比，前受血儿（TTTS - amnio，P = 0.006）和较大的MCDA双胎（P = 0.027）的双胎间旋转显著减少。在所有单绒毛膜组中，左心室舒张早期二尖瓣组织速度（MVE'）也呈现类似模式，但仅在TTTS - amnio双胎中达到显著水平（P = 0.037）。在Quintero III期或IV期治疗后，双胎对间的旋转和MVE'差异显著。
与接受激光光凝治疗的TTTS双胎及对照相比，接受羊水减量术治疗的TTTS双胎前受血儿在10岁时，双胎对间的左心室旋转和舒张功能模式存在差异。
