Assessment of Cardiac Function in Monochorionic Diamniotic Twin Pregnancies with Twin-to-Twin Transfusion Syndrome Before and After Fetoscopic Laser Photocoagulation Using Speckle Tracking

Abstract

Purpose: To assess cardiac function with Speckle tracking in fetuses with twin-to-twin transfusion syndrome (TTTS) before and after laser therapy.

Materials and Methods: A prospective case control study was conducted on 11 monochorionic diamniotic twin pairs with TTTS. Based on normal curves derived from healthy controls, global systolic longitudinal myocardial velocity, strain and strain rate values were transformed to z-scores.

Results: Right and left ventricular systolic global strain (–27.45 % and –22.41 %) and strain rate (–4.13/sec and –3.27/sec) were reduced in recipients compared with normal values and all parameters tended to decrease even more after treatment (RV and LV: strain –23.79 % and –20.21 %; strain rate: –3.67/sec and –2.87/sec). The corresponding measurements in donor fetuses revealed no statistical difference compared to reference values.

Conclusion: The global systolic myocardial function of donor twins before and after laser therapy was in the normal ranges. In contrast, recipient twins exhibited global cardiac dysfunction with decreased pre- and postoperative strain and strain rate. Speckle tracking can identify compromised ventricular myocardial function in fetuses with TTTS.

Zusammenfassung

Ziel: Beurteilung der kardialen Funktion mittels „Speckle Tracking“ bei Zwillingen mit feto-fetalem Transfusionssyndrom (FFTS) vor und nach Laserung.

Material und Methoden: Prospektive Fall-Kontroll-Studie an 11 monochorial diamnioten Gemini mit FFTS. Basierend auf Normwerten gesunder Kontroll-Feten wurden globale systolische longitudinale myokardiale Geschwindigkeiten, Strain und Strain Rate in Z-Scores transformiert.

Ergebnisse: Rechts- und linksventrikuläre systolische globale Strain (–27,45 % und –22,41 %) und Strain Rate (–4,13/s und –3,27/s) waren bei Rezipienten im Vergleich zu Normwerten gesunder Kontroll-Feten reduziert. Alle Parameter zeigten erst recht nach Laserung eine weiter abnehmende Tendenz (RV und LV: Strain –23,79 % und –20,21 %; Strain rate: –3,67/s und –2,87/s). Die entsprechenden Messungen an Donor-Feten zeigten im Vergleich zu Referenzwerten keine statistischen Differenzen.

Schlussfolgerung: Die globale systolische myokardiale Funktion der Donor-Feten vor und nach Lasertherapie lag im Normalbereich. Die Recipienten zeigten prä- und postoperativ eine globale kardiale Dysfunktion mit reduzierter Strain und Strain Rate. „Speckle-Tracking“-Technik kann eine kompromittierte ventrikuläre myokardiale Funktion bei Feten mit FFTS identifizieren.

Key words

cardiac - echocardiography - ultrasound 2 D - speckle tracking - fetus

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