Comparison of fetal myocardial contractility before and after laser photocoagulation of communicating vessels in twin-to-twin transfusion syndrome.

OBJECTIVES

To evaluate changes in myocardial contractility that occur after selective laser photocoagulation of communicating vessels (SLPCV) in fetuses from pregnancies complicated with twin-to-twin transfusion syndrome (TTTS).

METHODS

The study included 51 pregnant women between 16 and 26 weeks of gestation who underwent SLPCV due to TTTS. Ultrasonography was performed before SLPCV and on postoperative day 1, 3(4) and 7. Fetal heart contractility in both fetuses was evaluated by determining the shortening fractions of the left and right ventricles (FS LV and FS RV), and the myocardial performance index (Tei-Index).

RESULTS

There was a significant increase in postoperative FS LV and FS RV in recipients (from 35.7% to 44%, P = 0.037 and from 27.6% to 32.9%, P = 0.021, respectively). Pre-operative Tei-Index values for both the left (0.55) and right ventricle (0.6) were above normal. The mean postoperative Tei-Index for the left ventricle decreased significantly to 0.49 (P = 0.011), while no significant change was observed in the right ventricle (0.57). No significant differences between pre- and postoperative FS and Tei-Index values were noted in the donors.

CONCLUSIONS

SLPCV is reflected by a significantly increased myocardial contractility in recipients.