Home About us Contact
|
Home About us Contact | ||
|
|
||
Twin Transfusion Syndrome (twin + transfusion_syndrome)
Selected AbstractsCardiac outcomes of hydrops as a result of twin,twin transfusion syndrome treated with laser surgeryJOURNAL OF PAEDIATRICS AND CHILD HEALTH, Issue 1-2 2009Peter H Gray Aim: To determine cardiac outcomes of foetal hydrops as a result of twin,twin transfusion syndrome treated with laser surgery. Methods: Hydrops identified in 16 recipient foetuses with twin,twin transfusion syndrome was treated with laser ablation surgery to anastomotic vessels. Prior to laser surgery, the foetuses were assessed by echocardiography for cardiac abnormalities and ventricular and valvular dysfunction. After delivery, echocardiography was performed on 15 of the 16 newborn infants. Results: Foetal echocardiography indicated impaired biventricular function in the 16 hydropic foetuses. Five foetuses had little or no forward flow through the pulmonary valve, while four had pulmonary regurgitation. Following laser surgery performed at a mean of 22.9 weeks gestation, hydrops resolved in all cases. Delivery occurred at a mean of 33.6 weeks gestation. Post-natal echocardiography revealed cardiac abnormalities in five neonates, of whom three had right ventricular outflow tract obstruction. One preterm infant with severe pulmonary stenosis died with intractable cardiac failure. Conclusion: The majority of hydropic infants with twin,win transfusion syndrome have normal cardiac outcomes following intrauterine laser surgery. As up to one-third may have cardiac abnormalities, cardiological monitoring is recommended during the first year of life. [source] Idiopathic arterial calcification in infancy with twin,twin transfusion syndromePEDIATRICS INTERNATIONAL, Issue 4 2003Noboru Inamura No abstract is available for this article. [source] Resolution of mirror syndrome after successful fetoscopic laser photocoagulation of communicating placental vessels in severe twin,twin transfusion syndromePRENATAL DIAGNOSIS, Issue 12 2008Masakazu Matsubara No abstract is available for this article. [source] Twin,twin transfusion syndrome: mathematical modellingPRENATAL DIAGNOSIS, Issue 4 2008Jeroen P. H. M. van den Wijngaard Abstract Twin,twin transfusion syndrome (TTTS) represents a pregnancy complication with a high risk for perinatal mortality and postnatal morbidity. Mathematical models have been utilized to examine the mechanisms of disease and potential treatment modalities. We developed four consecutive models based on pathophysiology mechanisms. Conceptually, these models remained simple, but with increased complexity in details. We present our models tutorially with the necessary equations expressed in words. The aetiology of TTTS was related to AV anastomoses from donor to recipient and their growth commensurate with placental growth. We assessed that natural growth of placenta and foetuses causes the diameter and length of the AV, as well as the AV's pressure gradient, to increase proportional to gestational age. The AV transfusion then increases faster than natural foetal growth. A progressively increasing discordance subsequently develops, not compensated for by foetal growth. A simulation is performed to show how this discordance in blood volumetric development causes successive discordances in other functions, particularly renal, circulatory, and cardio-vascular, resulting in disease progression to the various stages of TTTS. In conclusion, mathematical modelling of TTTS has provided an understanding of the sequence of events that leads to the various presentations of TTTS stages as well as the efficacy of therapies. Copyright © 2008 John Wiley & Sons, Ltd. [source] Hemodynamic changes with phenotype reversal during pregnancy in twin,twin transfusion syndromePRENATAL DIAGNOSIS, Issue 10 2004G. C. Meyberg-Solomayer Abstract Objectives We report an atypical case of twin,twin transfusion syndrome (TTTS) in monochorionic-diamniotic twins with arterio-arterial anastomoses in which the former donor became the recipient during pregnancy. Methods Serial sonographic monitoring was performed. Results There was a phenotype reversal in TTTS concerning growth and amniotic fluid ending at 27 weeks, with the dominance of the former smaller donor. Doppler sonography changed from absent enddiastolic flow of the donor to normal values in both twins. The new recipient showed transient ascites, the now smaller actual donor (former recipient) developed progressive cardiomegaly, hypertrophy of the myocardium and mitral and tricuspid insufficiency at 29 weeks. Doppler sonography in the new donor deteriorated to highly pathologic flow in the venous system, leading to cesarean section. The donor fetus died 12 h after delivery because of myocardial decompensation. The recipient did very well and was discharged 8 weeks later from the neonatology unit. Conclusion This atypical course shows the importance of serial sonographic monitoring in pregnancies with TTTS. Copyright © 2004 John Wiley & Sons, Ltd. [source] Immediate outcome of twin,twin transfusion syndrome following selective laser photocoagulation of communicating vessels at the NSW Fetal Therapy CentreAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 2 2010N. MERIKI Objective:, To audit the outcome for laser photocoagulation for twin,twin transfusion syndrome (TTTS) as managed by the New South Wales Fetal Therapy Centre (NSW FTC). Methods: A retrospective cohort study. Outcome data were reviewed for referrals between June 2003 and June 2008. The outcome measures included the severity of TTTS at presentation, delivery details (gestational age at delivery, birth weight and Apgar score at 5 min) and perinatal outcome (spontaneous miscarriage, premature rupture of membranes, intrauterine death, placental abruption and neonatal death). Results: Seventy-nine patients were treated with laser therapy for stage I,IV TTTS (median stage III). Median gestational age at treatment was 20 weeks (range 16,25). Median gestational age at delivery was 32 weeks (range 24,40). Survival of at least one baby in this study was 90.7% (88.9% for anterior and 92.1% for posterior placenta), and of both babies was 60.0%. Median birth weight was 1788 g (range 490,3695). Median Apgar score was nine at 5 min. Three women required repeat laser treatment for persistent TTTS. Conclusions: Selective laser photocoagulation of communicating vessels remains the treatment of choice for TTTS. Referrals to the NSW FTC have increased from five cases in the last half of 2003, to 18 cases in the first half of 2008. Local outcome figures at least equal any in the published international literature and support a continued policy of centralised care in Australia. A two-year follow-up study on neonatal outcome for survivors is underway. [source] Selective fetoscopic laser ablation in 100 consecutive pregnancies with severe twin,twin transfusion syndromeAUSTRALIAN AND NEW ZEALAND JOURNAL OF OBSTETRICS AND GYNAECOLOGY, Issue 1 2009Robert B. CINCOTTA Aims: To report the perinatal outcomes of a large series of twin pregnancies with severe twin,twin transfusion syndrome (TTTS) managed with laser ablation surgery in an Australian tertiary perinatal centre and to compare the outcome with other large cohorts. Methods: The outcomes of 100 consecutive pregnancies with severe TTTS managed with selective fetoscopic laser ablation from March 2002 to June 2007 were examined. Survival and neonatal morbidity were analysed. Comparisons were made with the results from other studies of laser surgery with at least 100 pregnancies. Results: There were 100 women with TTTS treated with laser ablation; 34 stage II, 44 stage III and 22 at stage IV. Median gestation at time of laser was 21 weeks (range 18,28) and median gestation at delivery was 31 weeks (range 20,39). Overall perinatal survival rate was 151 of 200 (75.5%). Eighty five per cent had one or more surviving twins. The survival rate for stage IV TTTS was 88.6%, significantly better than for stage II (69.1%) and stage III (73.9%) pregnancies. The perinatal mortality rate for donors (30%) was not significantly different from recipients (19%), but the fetal death rate for donors was significantly greater than that for recipients (P = 0.03). Severe cerebral abnormalities were present in only 2.8% of newborns. The overall survival rate was comparable to other large series. Conclusions: These results for the management of severe TTTS are comparable to the best reported international series. Long-term follow-up is required and more research needs to be undertaken to further improve these results. [source] | ||||||||||