Fetal and Neonatal Circulatory Disorders in Twin to Twin Transfusion Syndrome (The Secondary Publication).

Publisher: Medical Association of Nippon Medical School Country of Publication: Japan NLM ID: 100935589 Publication Model: Print Cited Medium: Internet ISSN: 1347-3409 (Electronic) Linking ISSN: 13454676 NLM ISO Abbreviation: J Nippon Med Sch Subsets: MEDLINE

Original Publication: Tokyo : Medical Association of Nippon Medical School, 2000-

Fetofetal Transfusion*/diagnostic imaging ; Fetofetal Transfusion*/etiology ; Fetofetal Transfusion*/pathology ; Fetofetal Transfusion*/therapy; Fetus/*blood supply; Blood Volume ; Cardiomegaly/embryology ; Cardiomegaly/etiology ; Female ; Fetal Diseases/etiology ; Fetal Diseases/physiopathology ; Fetal Growth Retardation/etiology ; Fetoscopy ; Humans ; Low-Level Light Therapy ; Polyhydramnios/etiology ; Pregnancy ; Prognosis ; Pulmonary Valve Stenosis/embryology ; Pulmonary Valve Stenosis/etiology ; Renal Circulation ; Renin-Angiotensin System/physiology

Twin to twin transfusion syndrome (TTTS) is a major complication of monochorionic diamniotic (MD) twins, and its onset is known to be associated with placental vascular anastomoses and blood flow imbalance. In a typical case of TTTS, the recipient develops polyhydramnios, weight gain, cardiomegaly and hydrops fetalis in the uterus. In contrast, the donor develops oligohydramnios and intrauterine growth restriction. Recently, the significance of the renin-angiotensin-aldosterone system (RAAS) that transfers from the donor to the recipient has attracted interest in the fetal circulation of TTTS. The donor has decreased renal blood flow due to decreased circulating blood volume. For this reason, the secretion of RAAS hormones is augmented in the fetal kidneys of the donor. In TTTS, these RAAS hormones from the donor transfer to the recipient through the anastomosed vessels. In addition to excess preload, the recipient heart is exposed to excess afterload due to systemic vasoconstriction through RAAS hormones. Commonly occurring complications in the recipient include myocardial hypertrophy, atrioventricular valve regurgitation, and pulmonary valve stenosis or pulmonary atresia. Fetoscopic laser photocoagulation (FLP) has been introduced recently because neither mortality nor neurological morbidity have been satisfactorily improved with conventional treatment. FLP is a curative method that may improve the prognosis of TTTS. In Japan, this procedure has been performed frequently, and positive neurological outcomes have been achieved.

Keywords: cardiac anomaly; cardiomyopathy; fetoscopic laser photocoagulation (FLP); recipient; twin to twin transfusion syndrome (TTTS)

Date Created: 20190906 Date Completed: 20200206 Latest Revision: 20200206

20240829

10.1272/jnms.JNMS.2019_86-301

31484880