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Early manifestations and spectrum of recipient twin cardiomyopathy in twin–twin transfusion syndrome: relation to Quintero stage
Author(s) -
Michelfelder E.,
Gottliebson W.,
Border W.,
Kinsel M.,
Polzin W.,
Livingston J.,
Khoury P.,
Crombleholme T.
Publication year - 2007
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1002/uog.5211
Subject(s) - medicine , cardiology , cardiomyopathy , cardiac function curve , single center , doppler echocardiography , fetal echocardiography , pregnancy , fetus , prenatal diagnosis , heart failure , blood pressure , diastole , biology , genetics
Objectives To examine cardiac structural and functional changes in twin–twin transfusion syndrome (TTTS), relative to Quintero stage, as a means of evaluating the spectrum of cardiomyopathy in TTTS. Methods This was a cross‐sectional, retrospective study of 42 consecutive cases of TTTS referred to a single fetal therapy center. Quintero stages were assigned by standard criteria. Presence of ventricular hypertrophy, cardiomegaly, atrioventricular valve regurgitation (AVVR), ventricular systolic dysfunction and right ventricular outflow tract obstruction on fetal echocardiography were noted. The Doppler myocardial performance index (MPI), an index of global ventricular function, was calculated for both ventricles in subjects with adequate Doppler data. We compared cardiac changes across Quintero stages. Results There was no cardiomyopathy observed in donor twins. The majority of subjects presented at Quintero Stage I ( n = 14), II ( n = 14) or III ( n = 11), with fewer at Stages IV ( n = 2) or V ( n = 1). As early as Quintero Stages I and II, a significant proportion of recipient twins had ventricular hypertrophy (17/28, 61%), AVVR (6/28, 21%) or quantitative abnormalities in either right (12/24, 50%) or left (14/24, 58%) ventricular function. Increasing prevalence of biventricular systolic dysfunction and cardiomegaly accompanied advancing Quintero stage. Conclusions Changes in cardiac structure and function not reflected in Quintero staging occur in recipient twins early in the evolution of TTTS. Incorporation of cardiac findings into assessment of TTTS severity may prove useful in stratification of risk and treatment selection. Copyright © 2007 ISUOG. Published by John Wiley & Sons, Ltd.