Herberg Ulrike, Bolay Julian, Graeve Pauline, Hecher Kurt, Bartmann Peter, Breuer Johannes
Division of Pediatric Cardiology, University of Bonn, Bonn, Germany.
Division of Neonatology, University of Bonn, Bonn, Germany.
Arch Dis Child Fetal Neonatal Ed. 2014 Sep;99(5):F380-5. doi: 10.1136/archdischild-2013-305034. Epub 2014 Jun 27.
In twin-to-twin transfusion syndrome (TTTS), genetically identical twins are exposed to different haemodynamic conditions during fetal life, which are considered to be the cause of prenatal and postnatal cardiovascular differences between the donor and the recipient.
To assess intertwin differences on childhood cardiac outcome after intrauterine laser coagulation therapy (LC) of severe TTTS.
Prospective, detailed, echocardiographic follow-up of 31 twin pairs aged 9.95±0.8 years (mean±SD) with severe TTTS treated by LC, and the comparison with reference values.
Cardiac function was normal and did not show intertwin differences in twins without structural heart disease. Discordant birth weight or birth weight <3rd centile for gestational age had no influence on blood pressure and cardiac indices. Pulmonary stenosis was more common (5/62; 8.1%) than in the general population (prevalence 0.066%, relative risk 134.4, 95% CI 42.1 to 428.8, p<0.0001) and affected both donor and recipient. Intertwin differences in late diastolic right ventricular filling (peak velocities: recipient 0.51±0.11 m/s vs donor 0.45±0.10 m/s, mean difference 0.74 m/s, 95% CI 0.23 to 1.24, p=0.009) and early septal relaxation (mean myocardial velocities: recipient -8.2±1.5 cm/s vs donor -8.9±1.2 cm/s, mean difference 0.7 cm/s, 95% CI 0.02 to 1.38, p=0.044) were found only when twins with right heart disease were included.
Despite severe prenatal cardiac involvement, childhood cardiac function is normal in the majority of surviving donors and recipients after successful LC of severe TTTS. This underlines the favourable impact of intrauterine LC on postnatal cardiovascular performance.
在双胎输血综合征（TTTS）中，基因相同的双胞胎在胎儿期面临不同的血流动力学状况，这被认为是导致供体和受体产前及产后心血管差异的原因。
评估严重TTTS宫内激光凝固治疗（LC）后双胞胎儿童心脏结局的双胎间差异。
对31对年龄为9.95±0.8岁（均值±标准差）的严重TTTS双胞胎进行前瞻性、详细的超声心动图随访，并与参考值进行比较。
在无结构性心脏病的双胞胎中，心脏功能正常且未显示双胎间差异。出生体重不一致或出生体重低于胎龄第3百分位数对血压和心脏指数无影响。肺动脉狭窄比一般人群更常见（5/62；8.1%）（一般人群患病率0.066%，相对风险134.4，95%可信区间42.1至428.8，p<0.0001），且供体和受体均受影响。仅当纳入患有右心疾病的双胞胎时，才发现舒张晚期右心室充盈的双胎间差异（峰值速度：受体0.51±0.11m/s，供体0.45±0.10m/s，平均差异0.74m/s，95%可信区间0.23至1.24，p=0.009）和室间隔早期松弛（平均心肌速度：受体-8.2±1.5cm/s，供体-8.9±1.2cm/s，平均差异0.7cm/s，95%可信区间0.02至1.38，p=0.044）。
尽管产前心脏受累严重，但在严重TTTS成功进行LC后，大多数存活的供体和受体儿童期心脏功能正常。这突出了宫内LC对产后心血管功能的有利影响。
