Takano Mayumi, Hine Kotaro, Nagasaki Sumito, Sakuma Junya, Shimabukuro Makiko, Kotaki Hikari, Saito Keiko, Ogata Kohei, Yoda Hitoshi, Nakata Masahiko
Department of Obstetrics and Gynecology, Toho University Faculty of Medicine, Tokyo, Japan.
Department of Neonatology, Toho University Faculty of Medicine, Tokyo, Japan.
Prenat Diagn. 2022 Oct;42(11):1448-1457. doi: 10.1002/pd.6236. Epub 2022 Sep 18.
To investigate the differences in amniotic fluid cardiac biomarkers and clinical features among types of right ventricular outflow tract (RVOT) abnormality in monochorionic (MC) twins.
This prospective study included MC twins that underwent laser surgery. Recipient or larger twins (group A) and donor or smaller twins (group B) were assessed and divided into those with a normal right ventricular outflow tract (normal RVOT), functional pulmonary atresia (fPA), or pulmonary stenosis (PS). Amniotic fluid levels of NT-proBNP (afNT-proBNP) and cardiac troponin T (afTnT) were examined during surgery.
Of 190 fetuses in group A, there were 14 RVOT abnormality cases (including 7 fPA and 7 PS). No group B fetuses showed RVOT abnormality findings. In group A, later and earlier gestational age at surgery were observed in fPA (25.1 ± 2.8 weeks) and PS groups (17.8 ± 0.9 weeks). All survived PS cases demonstrated progressive pulmonary valve obstruction, not observed in fPA groups. AfNT-proBNP were significantly higher in fPA and PS than in the normal RVOT group (p < 0.05). AfTnT was significantly higher in group A with PS than fPA and normal RVOT groups (p < 0.05).
Among RVOT abnormality types in group A, amniotic fluid cardiac biomarkers were differently expressed, and clinical features were also differentiated. These findings provide insight into the pathophysiological influence on RVOT in MC twins.
This study was registered with the Japanese Clinical Trial Registry "UMIN-CTR" (http://www.umin.ac.jp/ctr/index-j.htm; trial ID numbers UMIN000024486 and 000037702).
探讨单绒毛膜（MC）双胎右心室流出道（RVOT）异常类型之间羊水心脏生物标志物及临床特征的差异。
这项前瞻性研究纳入了接受激光手术的MC双胎。对受血儿或较大双胎（A组）和供血儿或较小双胎（B组）进行评估，并分为右心室流出道正常（正常RVOT）、功能性肺动脉闭锁（fPA）或肺动脉狭窄（PS）的双胎。手术期间检测羊水NT-脑钠肽前体（afNT-proBNP）和心肌肌钙蛋白T（afTnT）水平。
A组190例胎儿中，有14例RVOT异常病例（包括7例fPA和7例PS）。B组胎儿未发现RVOT异常。在A组中，fPA组（25.1±2.8周）和PS组（17.8±0.9周）手术时的孕周较晚和较早。所有存活的PS病例均表现为进行性肺动脉瓣梗阻，fPA组未观察到。fPA组和PS组的afNT-proBNP显著高于正常RVOT组（p<0.05）。A组中PS组的afTnT显著高于fPA组和正常RVOT组（p<0.05）。
在A组的RVOT异常类型中，羊水心脏生物标志物表达不同，临床特征也有差异。这些发现为深入了解MC双胎中RVOT的病理生理影响提供了依据。
本研究已在日本临床试验注册中心“UMIN-CTR”（http://www.umin.ac.jp/ctr/index-j.htm；试验识别码UMIN000024486和000037702）注册。
