Changes in umbilical venous volume flow after fetoscopic laser occlusion of placental vascular anastomoses in twin-to-twin transfusion syndrome

Ahmet Alexander Baschat, Sadettin Gungor, Peter Glosemeyer, Agnes Huber, Kurt Hecher

Research output: Contribution to journalArticle

Abstract

Objective To examine effects of fetoscopic laser occlusion of placental vascular anastomoses on umbilical venous volume flow in twin-to-twin transfusion syndrome. Study Design Absolute umbilical venous volume flow, measured preoperatively and 48 hours after fetoscopic laser occlusion was related to Doppler studies, bladder filling in donors, and anastomoses. Results Among 45 patients, recipients had decreased ductus venosus pulsatility index (ductus venosus-pulsatility index for veins, 1.16 vs 1.01; P < .001) and unchanged umbilical venous volume flow after fetoscopic laser occlusion (74.7 vs 74.5 mL; P = .407). Donors had decreased umbilical artery pulsatility (1.34 vs 1.11; P = .008), increased ductus venous-pulsatility index for veins (0.75 vs 0.91; P < .014), and significantly increased umbilical venous volume flow per kilogram by 52.3% (136.6 vs 208.0 mL/Kg/min; P < .001). Donor bladder filling occured at higher umbilical venous volume flow per kilogram (142.7 vs 221.4 mL/Kg/min; P < .012). Increase in umbilical venous volume flow per kilogram correlated with the net difference in arteriovenous anastomoses (Pearson r = 0.403, P = .006). Conclusion Fetoscopic laser occlusion in twin-to-twin transfusion syndrome corrects intertwin differences in umbilical venous volume flow by predominant effects in the donor. Reappearance of donor bladder filling correlates with correction of volume flow.

Original languageEnglish (US)
Pages (from-to)479.e1-479.e6
JournalAmerican journal of obstetrics and gynecology
Volume203
Issue number5
DOIs
StatePublished - Nov 2010
Externally publishedYes

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Keywords

  • Doppler
  • Key words
  • ductus venosus
  • fetoscopy
  • laser occlusion
  • twin-twin transfusion
  • umbilical venous volume flow

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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