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

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