Assessment of fetal cardiovascular function after radio-frequency ablation in complicated monochorionic diamnionic twins / 中华实用儿科临床杂志

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) TTTSCVPS [(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);CVPS [(9.29-± 0.95) scores] had no statistical significance 1 month postoperatively (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-Tei0.66 ± 0.19,RV-Tei0.63 ± 0.12) with significant difference (LVt =-3.193,P ＜ 0.05;RVt =-3.565,P ＜ 0.05),but there was no statistical significance 1 month after operation(all P ＞ 0.05) as compared with the controls (LV-Tei0.35-± 0.03,RV-Tei0.35-± 0.03).(2) sIUGRCVPS [(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-Tei0.39 ± 0.04 vs.0.47 ± 0.06,t =-6.687,P ＜ 0.01;RV-Tei0.38 ± 0.04 vs.0.47 ± 0.05,t =-6.000,P ＜ 0.01).Compared with the controls,RV-Tei (0.38 ± 0.04)had no statistical significance 1 week after operation (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 postoperatively.In sIUGR,its cardiovascular function is recovered completely 1 week postoperatively.