Inter-twin differences in fetal echocardiographic findings are associated with decreased dual twin survival in twin-twin transfusion syndrome

Abstract

Objective

To determine if inter-twin differences in fetal echocardiographic findings are associated with fetal survival in monochorionic pregnancies complicated by twin-to-twin transfusion syndrome (TTTS).

Methods

This study included women who underwent laser surgery for TTTS between 2012 and 2018 at a single institution. Echocardiographic cardiac parameters in the donor and recipient twins were compared using Z-scores and regression analyses (adjusted for confounding variables) to determine whether any measurable inter-twin differences were associated with neonatal survival at birth. Results are expressed as (Odds ratio [95% confidence interval], p-value).

Results

Fetal echocardiography and delivery information was available in 124 TTTS cases. Dual live-birth occurred in 72% and at least one live-birth was seen in 89% of cases.

Sixty-four percent (51/79) of recipient twins had evidence of cardiac dysfunction compared to 10% (8/79) of the donor twins (p < .01). In the logistic regression, inter-twin differences in left ventricle short axis dimension (0.62[0.44–0.87], p < .01), aortic valve diameter (0.67[0.45–0.99], p = .047), peak systolic velocity across the pulmonary artery (PA-PSV) (0.09[0.01–0.53], p < .01) and mitral valve diameter (0.56[0.38–0.84], p < .01) were associated with lower dual twin survival at birth.

Conclusion

Inter-twin differences in left cardiac geometry and function are associated with decreased survival at delivery in TTTS.

Keywords:

• Twin-Twin transfusion syndrome
• fetal therapy
• monochorionic
• twin
• fetoscopic laser coagulation

Disclosure statement

No potential conflict of interest was reported by the author(s).

Data availability statement

The data that support the findings of this study are available from the corresponding author upon request.