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Fetal cardiovascular alterations in twin-to-twin transfusion syndrome.
Med Pharm Rep. 2020 Jan; 93(1):5-11.MP

Abstract

Twin-to-twin transfusion syndrome (TTTS) is the consequence of vascular anastomoses of the shared placenta of monochorionic twin pregnancies. Both circulating inter-twin blood flow and vasoactive mediators imbalance cause hypovolemia in the donor and hypervolemia in the recipient fetus. If left untreated, TTTS has a high perinatal mortality rate and adverse long-term outcomes mainly cardiovascular and neurological. The recipient has cardiovascular changes including atrioventricular valve regurgitation, diastolic dysfunction and pulmonary stenosis/atresia. The maladaptive response to vascular changes determines a constant decreased blood flow in the donor that permanently modifies the arterial structure leading to postnatal alterations in the vascular system. Fetoscopic LASER surgery of placental vascular anastomoses may disrupt the underlying pathophysiology and improves cardiovascular function with normalization of systolic and diastolic function within weeks after treatment. The impact of cardiovascular changes is relevant for the safety of the management of a TTTS case. The improvement of the perinatal survival after intrauterine surgery leads to viable infants with the longer-term sequelae. Therefore accurate quantification of cardiovascular involvement is essential for clinicians for pregnancy management but also for patient counseling about the potential treatment options the outcome.

Authors+Show Affiliations

1 Department of Obstetrics and Gynecology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania. 1 Clinic of Obstetrics and Gynecology, Emergency County Hospital, Cluj-Napoca, Romania.Neonatal Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania. Neonatal Department, Emergency County Hospital, Cluj-Napoca, Romania.1 Department of Obstetrics and Gynecology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.1 Department of Obstetrics and Gynecology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.1 Department of Obstetrics and Gynecology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania. 1 Clinic of Obstetrics and Gynecology, Emergency County Hospital, Cluj-Napoca, Romania.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

32133441

Citation

Rotar, Ioana Cristina, et al. "Fetal Cardiovascular Alterations in Twin-to-twin Transfusion Syndrome." Medicine and Pharmacy Reports, vol. 93, no. 1, 2020, pp. 5-11.
Rotar IC, Zaharie G, Staicu A, et al. Fetal cardiovascular alterations in twin-to-twin transfusion syndrome. Med Pharm Rep. 2020;93(1):5-11.
Rotar, I. C., Zaharie, G., Staicu, A., Preda, A., & Mureşan, D. (2020). Fetal cardiovascular alterations in twin-to-twin transfusion syndrome. Medicine and Pharmacy Reports, 93(1), 5-11. https://doi.org/10.15386/mpr-1481
Rotar IC, et al. Fetal Cardiovascular Alterations in Twin-to-twin Transfusion Syndrome. Med Pharm Rep. 2020;93(1):5-11. PubMed PMID: 32133441.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Fetal cardiovascular alterations in twin-to-twin transfusion syndrome. AU - Rotar,Ioana Cristina, AU - Zaharie,Gabriela, AU - Staicu,Adelina, AU - Preda,Andreia, AU - Mureşan,Daniel, Y1 - 2020/01/31/ PY - 2019/10/06/received PY - 2019/12/15/revised PY - 2019/12/30/accepted PY - 2020/3/6/entrez PY - 2020/3/7/pubmed PY - 2020/3/7/medline KW - donor fetus KW - monochorionic diamniotic twin pregnancies KW - recipient fetus KW - twin-to-twin transfusion syndrome KW - vascular anastomosis SP - 5 EP - 11 JF - Medicine and pharmacy reports JO - Med Pharm Rep VL - 93 IS - 1 N2 - Twin-to-twin transfusion syndrome (TTTS) is the consequence of vascular anastomoses of the shared placenta of monochorionic twin pregnancies. Both circulating inter-twin blood flow and vasoactive mediators imbalance cause hypovolemia in the donor and hypervolemia in the recipient fetus. If left untreated, TTTS has a high perinatal mortality rate and adverse long-term outcomes mainly cardiovascular and neurological. The recipient has cardiovascular changes including atrioventricular valve regurgitation, diastolic dysfunction and pulmonary stenosis/atresia. The maladaptive response to vascular changes determines a constant decreased blood flow in the donor that permanently modifies the arterial structure leading to postnatal alterations in the vascular system. Fetoscopic LASER surgery of placental vascular anastomoses may disrupt the underlying pathophysiology and improves cardiovascular function with normalization of systolic and diastolic function within weeks after treatment. The impact of cardiovascular changes is relevant for the safety of the management of a TTTS case. The improvement of the perinatal survival after intrauterine surgery leads to viable infants with the longer-term sequelae. Therefore accurate quantification of cardiovascular involvement is essential for clinicians for pregnancy management but also for patient counseling about the potential treatment options the outcome. SN - 2668-0572 UR - https://www.unboundmedicine.com/medline/citation/32133441/Fetal_cardiovascular_alterations_in_twin-to-twin_transfusion_syndrome L2 - https://www.ncbi.nlm.nih.gov/pmc/articles/pmid/32133441/ DB - PRIME DP - Unbound Medicine ER -
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