Chaszczewski Kasey J, Perelman Sarah, Falkensammer Christine B, Szwast Anita, Pang Chengcheng, Tian Zhiyun, Gebb Juliana, Moldenhauer Julie, Khalek Nahla, Rychik Jack
Herma Heart Institute, Children's Wisconsin, Milwaukee, Wisconsin, USA.
Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
Prenat Diagn. 2025 Jun;45(6):787-794. doi: 10.1002/pd.6805. Epub 2025 Apr 26.
Cardiovascular disturbances are common in twin-twin transfusion syndrome (TTTS). However, the rate of improvement in cardiovascular burden in response to selective fetoscopic laser photocoagulation (SFLP) is not well known.
Fetal echocardiograms were performed prior to and 1 week following SFLP. Cardiovascular burden was characterized using the Children's Hospital of Philadelphia (CHOP) TTTS Cardiovascular (CV) Score. Pulsatility indices (PI) of the umbilical artery (UA) and middle cerebral artery (MCA), cerebroplacental ratio (CPR) and elements of CHOP CV Score were analyzed pre and post SFLP.
SFLP was performed in 198 subjects; 17 were excluded due demise post SFLP. Following SFLP, recipient (R) demonstrated an increase in MCA PI and a decrease in UA PI, with an increase in CPR. Donor (D) demonstrated a similar magnitude decrease in MCA PI and UA PI, yielding no change in CPR. Following SFLP, the mean CHOP CV Score decreased. The magnitude of change was greater in the subgroup with greater pre-SFLP cardiovascular burden (CHOP CV Score ≥ 6).
Improvement in CV burden is seen as early as 1-week post-SFLP, supporting acute alteration of loading conditions as a significant contributor. Further study of the trajectory of CV alterations may provide insight into the complex mechanisms underlying TTTS.
双胎输血综合征（TTTS）中常见心血管紊乱。然而，选择性胎儿镜激光凝固术（SFLP）后心血管负担的改善率尚不清楚。
在SFLP前和术后1周进行胎儿超声心动图检查。使用费城儿童医院（CHOP）TTTS心血管（CV）评分来表征心血管负担。分析SFLP前后脐动脉（UA）和大脑中动脉（MCA）的搏动指数（PI）、脑胎盘比率（CPR）以及CHOP CV评分的各项指标。
198名受试者接受了SFLP；17名因SFLP后死亡被排除。SFLP后，受血儿（R）的MCA PI升高，UA PI降低，CPR升高。供血儿（D）的MCA PI和UA PI有类似程度的降低，CPR无变化。SFLP后，CHOP CV评分的平均值降低。SFLP前心血管负担较重（CHOP CV评分≥6）的亚组变化幅度更大。
CV负担早在SFLP后1周就有所改善，这支持了负荷条件的急性改变是一个重要因素。对CV改变轨迹的进一步研究可能有助于深入了解TTTS的复杂机制。
