Lee Yoo Jin, Lee Mi-Young, Jeong Jae Yi, Koh Jihye, Chung Jin Hoon, Won Hye-Sung
Department of Obstetrics and Gynecology, University of Ulsan College of Medicine, Asan Medical Center, 88 Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, South Korea.
BMC Pregnancy Childbirth. 2025 Oct 3;25(1):1009. doi: 10.1186/s12884-025-08195-7.
To investigate the characteristics of right ventricular outflow tract obstruction (RVOTO) in recipient twins of twin-to-twin transfusion syndrome (TTTS), including its prevalence, perinatal outcomes, and the impact of fetoscopic laser coagulation (FLC) on postnatal RVOTO status.
This retrospective study included recipient twins of TTTS treated with FLC at the Asan Medical Center between January 2011 and December 2023. Among those diagnosed with RVOTO, the recipient twins were categorized into two groups based on postnatal outcomes: RVOTO improvement versus persistence. Prenatal ultrasound findings and neonatal outcomes were compared between the groups. To identify the predisposing factors for RVOTO, the entire recipient population was divided into RVOTO and non-RVOTO groups, followed by univariate and multivariable logistic regression analyses.
Among the 284 TTTS cases, 24 recipient twins (8.5%) were diagnosed with RVOTO. RVOTO improved following FLC in 7 cases (29.2%). In the remaining 17 cases with persistent RVOTO, six were stillbirths. In the 11 survivors, five had mild RVOTO and required no intervention, while six underwent intervention (four with balloon valvuloplasty and two with surgical correction). Multivariate analysis identified the initial Quintero stage (odds ratio [OR] 2.64), pulsatile umbilical vein (OR 3.44), and tricuspid regurgitation (OR 30.66) as significant independent risk factors for RVOTO.
RVOTO is a relatively common cardiac complication in advanced TTTS. Timely FLC may lead to postnatal improvement. Serial ultrasound assessment is essential for early detection, risk stratification, and individualized counseling.
探讨双胎输血综合征（TTTS）受血儿双胎右心室流出道梗阻（RVOTO）的特征，包括其发生率、围产期结局以及胎儿镜激光凝固术（FLC）对出生后RVOTO状态的影响。
这项回顾性研究纳入了2011年1月至2023年12月在峨山医疗中心接受FLC治疗的TTTS受血儿双胎。在那些被诊断为RVOTO的受血儿双胎中，根据出生后结局分为两组：RVOTO改善组与持续组。比较两组的产前超声检查结果和新生儿结局。为了确定RVOTO的易感因素，将整个受血儿人群分为RVOTO组和非RVOTO组，然后进行单因素和多因素逻辑回归分析。
在284例TTTS病例中，24例受血儿双胎（8.5%）被诊断为RVOTO。7例（29.2%）在FLC后RVOTO得到改善。在其余17例持续性RVOTO病例中，6例为死产。在11例存活者中，5例有轻度RVOTO，无需干预，而6例接受了干预（4例行球囊瓣膜成形术，2例行手术矫正）。多因素分析确定初始Quintero分期（比值比[OR]2.64）、搏动性脐静脉（OR 3.44）和三尖瓣反流（OR 30.66）是RVOTO的重要独立危险因素。
RVOTO是晚期TTTS中一种相对常见的心脏并发症。及时进行FLC可能导致出生后情况改善。连续超声评估对于早期检测、风险分层和个体化咨询至关重要。
