Asymmetrical Hemodynamic Influence of Twin-Twin Transfusion Syndrome on Fetal E/e' by the Dual Gate Doppler Method in Recipient Twins.

OBJECTIVES

To assess the hemodynamic influence of twin-twin transfusion syndrome (TTTS) on diastolic function, using left ventricle (LV) and right ventricle (RV) E/e' measured in the same cardiac cycle using the dual-gate Doppler (DD) method.

METHODS

This study included 56 monochorionic twin pregnancies that underwent fetoscopic laser surgery (FLS) for TTTS in 2015-2018. E/e' by the DD method was measured 24 h before and 4-7 days after FLS.

RESULTS

Recipients showed higher LV-E/e' Z score in stage I-, II-, and III-recipients (IIIr) and higher RV-E/e' Z score in stage III-donors and IIIr than donors (p < 0.05). After FLS, LV-E/e' Z score of recipients significantly decreased due to LV-E velocity Z score decrease (p < 0.05). RV-E/e' Z score after FLS significantly decreased due to RV-e' velocity Z score increase in recipients (p < 0.05).

CONCLUSIONS

E/e' by the DD method helped assess cardiac changes of recipients. LV-E/e' could assess early hemodynamic changes by TTTS, and RV-E/e' can assess later influence on cardiac diastolic function. Furthermore, in recipient twins, the decrease in LV-E/e' after FLS might reflect the improvement of volume overload and the decrease in RV-E/e' might reflect the improvement of diastolic relaxation function in the RV.