Fetal ventricular long axis function in twin-to-twin transfusion syndrome before and after laser surgery

Objectives: To evaluate mitral and tricuspid annular plane systolic excursion (MAPSE/TAPSE) in fetuses of monochorionic twin pregnancies complicated with twin-to-twin transfusion syndrome (TTTS) before and after laser therapy and in normal monochorionic twins.

Methods: A prospective study including 30 fetal pairs with TTTS and 13 gestational age-matched normal monochorionic fetal pairs. Fetal echocardiography was performed within 24 hours before and within 48 hours after fetoscopy including MAPSE/TAPSE in an apical or basal four-chamber view by placing the M-mode cursor at the lateral valve ring, and measuring the maximum displacement between end systole and end diastole.

Results: Preoperative MAPSE and TAPSE were significantly reduced in both recipients and donors (Table 1). There were no acute changes on MAPSE/TAPSE neither in donors nor in recipients after fetoscopy. When subdividing according to Quintero stages, MAPSE and TAPSE in donors were significantly decreased in both stages I-II and III-IV when compared to normal monochorionic pregnancies. No cases of right ventricle tract obstruction were observed.

Conclusion: This study provides evidence that both recipient and donor twins present a decreased myocardial longitudinal motility, even in early TTTS stages. These results warrant future studies to assess the postnatal persistence of cardiac dysfunction in operated TTTS twins.

Tab. 1

	GA at diagnosis (weeks)	MAPSE Z-score	TAPSE Z-score
Control	21.0 (14.4 – 26.3)	-0.45 (1.00)	-0.68 (0.63)
Donor	20.6 (15.7 – 28.7)	-0.84 (0.51)*	-1.39 (0.53)*
Recipient	20.6 (15.7 – 28.7)	-0.84 (0.72)*	-1.12 (0.54)*