Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA.
Texas Children's Hospital Pavilion for Women, Houston, Texas, USA.
J Ultrasound Med. 2021 Jan;40(1):71-78. doi: 10.1002/jum.15377. Epub 2020 Jul 10.
To evaluate the association of abnormal Doppler velocimetric patterns in the umbilical arteries (UAs) and right ventricular outflow tract abnormalities (RVOTAs) in twin- twin transfusion syndrome (TTTS) cases.
This retrospective study involved women who had laser surgery for TTTS between January 2012 and May 2018 at a single institution. The prevalence of an RVOTA in either twin was compared among TTTS cases in which both twins had positive end-diastolic flow (EDF) in the UA and those in which either twin had intermittent or persistent absent/reversed UA EDF. Nonparametric tests were used for comparisons. Logistic regression was performed to identify variables associated with an RVOTA in either twin, adjusted for moderate or severe tricuspid regurgitation, right ventricular hypertrophy, right ventricular systolic or diastolic dysfunction, the Quintero stage, and other confounders. P < .05 was considered significant.
A total of 126 consecutive TTTS cases were included. Right ventricular outflow tract abnormalities were seen in 8.7% (11of 126) of cases, all in recipient twins. Significant differences in the rate of RVOTAs in the recipient twin were seen between TTTS cases with intermittent absent/reversed UA EDF and those with positive UA EDF (26.9% [7 of 26] versus 3.7% [3 of 82]; P = .002]. However, no significant differences were noted among the other study groups. Intermittent absent/reversed UA EDF was associated with a significantly increased risk for an RVOTA (adjusted odds ratio, 20.6 [95% confidence interval, 3.1-138]; P = .002) after adjusting for confounders.
Intermittent changes in vascular impedance to UA flow may contribute to the pathogenesis of acquired right-sided cardiac lesions in the recipient twin affected with TTTS.
评估双胎输血综合征（TTTS）病例中脐动脉（UA）异常多普勒速度模式与右心室流出道异常（RVOTA）的相关性。
本回顾性研究纳入了 2012 年 1 月至 2018 年 5 月在一家单中心接受激光手术治疗 TTTS 的女性。比较了两种情况下双胎中的 RVOTA 发生率：一种是双胎 UA 均为舒张末期正向血流（EDF），另一种是其中一个胎儿的 UA EDF 为间歇性或持续性缺失/反转。采用非参数检验进行比较。采用逻辑回归分析确定与双胎中任一胎儿 RVOTA 相关的变量，调整因素包括中度或重度三尖瓣反流、右心室肥厚、右心室收缩或舒张功能障碍、Quintero 分期和其他混杂因素。P<.05 被认为具有统计学意义。
共纳入 126 例连续 TTTS 病例。8.7%（11/126）的病例存在 RVOTA，均见于受血儿。UA EDF 间歇性缺失/反转的 TTTS 病例与 UA EDF 阳性的 TTTS 病例相比，受血儿的 RVOTA 发生率存在显著差异（26.9%[7/26]比 3.7%[3/82]；P=.002）。然而，其他研究组之间未见显著差异。UA EDF 间歇性缺失/反转与 RVOTA 显著相关（调整后优势比，20.6[95%置信区间，3.1-138]；P=.002），调整混杂因素后。
UA 血流血管阻抗的间歇性变化可能导致受 TTTS 影响的受血儿右心病变的发病机制。
