Impact of selective fetoscopic laser photocoagulation for twin-twin transfusion syndrome on myocardial deformation

Abstract

To investigate the changes in myocardial deformation in donor and recipient hearts in response to selective fetoscopic laser photocoagulation (SFLP) for twin-twin transfusion syndrome (TTTS). Totally 25 twin pairs before 24-hour and 1 week after SFLP had fetal echocardiography and digital dynamic two-dimensional four chamber views which were interrogated off-line using velocity vector imaging (VVI) software. Global longitudinal strain (S), systolic strain rate (SRs) and diastolic strain rate (SRd) were measured off-line in the left (LV) and right (RV) ventricles. In the donor, SFLP resulted in increase in cardiothoracic ratio (CTR, 0.29 ± 0.03 versus 0.34 ± 0.05, P < 0.01), with development of new onset tricupid regurgitation (n = 7) and pericardial effusion (n = 5) and worsening of all measures of myocardial deformation in both systole and diastole for LV and RV [LV-S: (-19.24 ± 3.68)% versus (-13.78 ± 3.64)%, P < 0.01; LV-SRs: (-2.28 ± 0.53) versus (-1.43 ± 0.41) s(-1), P < 0.01; LV-SRd: (1.67 ± 0.43) versus (1.15 ± 0.70) s(-1), P < 0.01; RV-S: (-20.20 ± 3.19)% versus (-16.10 ± 3.07)%, P < 0.01; RV-SRs: (-2.03 ± 0.65) versus (-1.72 ± 0.38) s(-1), P < 0.05; RV-SRd: (1.71 ± 0.30) versus (1.50 ± 0.36) s(-1), P < 0.05]. In the recipient, CTR decreased (0.42 ± 0.04 versus 0.37 ± 0.04, P < 0.01) and all parameters for both LV and RV improved substantially [LV-S: (-10.62 ± 2.72)% versus (-16.46 ± 3.23)%, LV-SRs: (-1.09 ± 0.30) versus (-1.60 ± 0.31) s(-1), LV-SRd: (0.99 ± 0.34) versus (1.53 ± 0.32) s(-1), RV-S: (-11.66 ± 4.56)% versus (-17.96 ± 3.97)%, RV-SRs: (-1.26 ± 0.39) versus (-1.74 ± 0.45) s(-1), RV-SRd: (1.15 ± 0.49) versus (1.63 ± 0.44) s(-1); all P < 0.01]. Myocardial deformational mechanics improve in the recipient but worsen in the donor following SFLP for TTTS.