Assessment of fetal cardiovascular function after radio-frequency ablation in complicated monochorionic diamnionic twins

Abstract

Objective To evaluate retained fetal cardiovascular function after radio frequency ablation in complicated monochorionic diamnionic twins. Methods A total of 19 complicated monochorionic diamnionic twins [10 twin-twin transfusion syndrome (TTTS) and 9 selective intrauterine growth restricted (sIUGR)] who were diagnosed at Fetal Medicine Center of the First Affiliated Hospital of Sun Yat-Sen University from December 2013 to July 2015 were enrolled, and the cardiovascular profile score (CVPS) and Tei index of retained fetus were measured preoperatively and postoperatively at 24 h, 3 days, 1 week, 1 month, 2 months respectively.Each case was matched by normal fetuses with same gestational age as control group and the same parameters were measured. Results (1) TTTS: CVPS [(8.71±1.11) scores] was increased significantly at 3 days postoperatively compared with preoperation [(6.86±2.12) scores], and there was a statistical significance(t=2.571, P 0.05) as compared with controls [(10.00±0.00) scores]. Tei indexes of the left ventricle (LV-Tei) (0.41±0.06) and Tei indexes of the right ventricle (RV-Tei)(0.42±0.06) decreased as compared with those before operation (LV-Tei: 0.66±0.19, RV-Tei: 0.63±0.12) with sig-nificant difference (LV: t=-3.193, P 0.05) as compared with the controls (LV-Tei: 0.35±0.03, RV-Tei: 0.35±0.03). (2)sIUGR: CVPS [(9.71±0.45) scores ]showed no statistical significance 1 week after operation (P>0.05) as compared with controls[(10.00±0.00) scores]. Tei indexes of the right and left ventricle 1 week after operation were lower than after operation with significant difference(LV-Tei: 0.39±0.04 vs.0.47±0.06, t=-6.687, P 0.05), LV-Tei(0.36±0.02) showed no statistical significance 1 month after operation(P>0.05). Conclusions Retained fetal cardiovascular function of TTTS and sIUGR can be restored obviously after operation.In TTTS, its cardiovascular function is recovered completely 1 month postope-ratively.In sIUGR, its cardiovascular function is recovered completely 1 week postoperatively. Key words: Monochorionic diamnionic twins; Radio frequency; Ablation; Cardiac function; Echocardiogram