目的:评估双胎输血综合征(TTTS)的血流动力学,我们测量了心室内压差(IVPD),心肌舒张功能的敏感标志,使用胎儿超声心动图。
方法:我们纳入了28位诊断为TTTS的单绒毛膜双胎(MD)双胞胎,他们在2018年至2022年之间接受了胎儿镜激光光凝(FLP)。FLP前后获得两个心室的彩色M模式多普勒图像。根据这个评价,IVPD分为三组;那些总共,基底,和心尖中期IVPD.
结果:在28对双胞胎中,21个可用于分析(包括8个,八,三,以及QuinteroⅠ阶段的两个案例,Ⅱ,Ⅲd,和Ⅲr,分别)。比较前和后FLP结果,观察到受体双胞胎左心室(LV)的总和中尖IVPD显著增加(总和中尖IVPD:分别为p=0.026和0.013).在供体双胞胎的LV中,FLP后所有IVPDs均显着增加(总,基底,和中尖IVPD:p分别为0.003、0.001和0.022)。此外,供体组和受体组之间的比较未显示FLP前任一心室的显著差异.
结论:IVPD检测到细微的血流动力学变化,FLP前后TTTS的容量超负荷和舒张功能障碍。因此,IVPD可能是监测TTTS心肌舒张功能的有用标志物。
OBJECTIVE: To assess the hemodynamics of twin-to-twin transfusion syndrome (TTTS), we measured the intraventricular pressure difference (IVPD), a sensitive marker of myocardial diastolic function, using fetal echocardiography.
METHODS: We included 28 monochorionic diamniotic (MD) twins diagnosed with TTTS who underwent fetoscopic laser photocoagulation (FLP) between 2018 and 2022. Color M-mode Doppler images of both cardiac ventricles were obtained before and after FLP. According to this evaluation, the IVPDs were divided into three groups; those with total, basal, and mid-apical IVPD.
RESULTS: Of the 28 twins, 21 were available for analysis (including eight, eight, three, and two cases in stages Quintero Ⅰ, Ⅱ, Ⅲd, and Ⅲr, respectively). Comparing the pre and postFLP results, significant increases in total and mid-apical IVPD in the left ventricle (LV) of recipient twins were noted (total and mid-apical IVPD: p=0.026 and 0.013, respectively). In the LV of the donor twins, all IVPDs were significantly increased after FLP (total, basal, and mid-apical IVPD: p=0.003, 0.001, and 0.022, respectively). In addition, comparisons between the donor and recipient groups did not show significant differences in either ventricle before FLP.
CONCLUSIONS: IVPD detected subtle hemodynamics changes, such as volume overload and diastolic dysfunction in TTTS before and after FLP. Therefore, IVPD may be a useful marker for monitoring myocardial diastolic function in TTTS.