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Am J Perinatol 2014; 31(S 01): S39-S46
DOI: 10.1055/s-0034-1384641
Review Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Role of Adjunctive Medical Therapy in the Fetoscopic Surgical Treatment of Twin–Twin Transfusion Syndrome

Michael V. Zaretsky
1   Division of Maternal Fetal-Medicine, Colorado Institute of Maternal Fetal Health, The University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
,
Stig Somme
2   Department of Pediatric General Thoracic and Fetal Surgery, Colorado Institute of Maternal Fetal Health, The University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
,
Timothy M. Crombleholme
2   Department of Pediatric General Thoracic and Fetal Surgery, Colorado Institute of Maternal Fetal Health, The University of Colorado School of Medicine, Children's Hospital Colorado, Aurora, Colorado
› Author Affiliations
Further Information

Publication History

13 February 2014

14 May 2014

Publication Date:
31 July 2014 (online)

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Abstract

The underlying etiology of twin–twin transfusion syndrome (TTTS) is unknown, but our growing understanding of the cardiovascular features of TTTS suggests this may be a disease that could respond to transplacental medical therapy. Adjunctive medical therapy in TTTS with the calcium channel blocker nifedipine has been shown to improve recipient survival while having no effect on the donor. There is no significant difference in recipient survival from postoperative day 5 to birth suggesting that the survival benefit is confined to the effects of nifedipine in the perioperative period. Also, there is no significant effect of nifedipine on gestational age at delivery suggesting the survival benefit was unrelated to the tocolytic effects of nifedipine and more likely a result of hemodynamic effects in the recipient twins' cardiovascular system during the perioperative period. TTTS remains poorly understood but there appears to be good evidence suggesting twin–twin hypertensive cardiomyopathy is a large component of the pathophysiology in recipient twins. The initial findings of nifedipine's effectiveness as a targeted medical therapy to address TTTS cardiomyopathy and improve survival of recipient twins opens the door for further research for adjunctive medical therapies in TTTS.

Keywords

twin–twin transfusion syndrome - nifedipine - twin–twin transfusion syndrome cardiomyopathy - fetoscopic laser surgery
 

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