Impact of selective fetoscopic laser photocoagulation for twin-twin transfusion syndrome on myocardial deformation / 中华妇产科杂志

ABSTRACT

Objective To investigate the changes in myocardial deformation in donor and reeipient hearts in response to selective fetoscopic laser photocoagulation (SFLP) for twin-twin transfusion syndrome (TTTS).Methods 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.Results 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 ].Conclusion Myocardial deformational mechanics improve in the recipient but worsen in the donor following SFLP for TTTS.