彩色多普勒超声及二维应变成像评价双胎输血综合征胎儿心功能的临床研究
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摘要
目的探讨二维应变成像在评价双胎输血综合征(twin-twin transfusion syndrome, TTTS)受血儿右心功能中的价值。
方法选择TTTS 16例及正常单绒毛膜囊双羊膜囊双胎19例,分别测量两个胎儿脐动脉、脐静脉、静脉导管、大脑中动脉、房室瓣口、半月瓣口等部位的血流频谱参数,计算心肌做功指数。然后局部放大胎儿四腔心,清晰显示心内膜及肌层,动态存储2~3个心动周期,脱机分析两组胎儿右心纵向收缩期峰值应变。
结果(1)TTTS受血儿心胸面积比值、右心心肌做功指数大于供血儿及对照组,差异有显著性意义。(2)TTTS受血儿右心游离壁、室间隔及平均纵向收缩期峰值应变小于供血儿及对照组,差异有显著性意义。
结论二维应变成像可反映TTTS受血儿的右心心肌运动异常,但是在羊水过多及胎动频繁时应用受到限制。
目的探讨彩色多普勒超声在评价双胎输血综合征受血儿心功能中的价值。
方法选择TTTS 17例,孕龄为16.4~29.2周,平均(23.2±3.4)周。常规测量胎儿双顶径、头围、腹围及股骨长;系统扫查胎儿全身结构;测量胎儿脐动脉、脐静脉、静脉导管、大脑中动脉等血流参数;测量胎儿心胸面积比值及房室瓣、半月瓣的血流参数,计算心肌做功指数。
结果(1)受血儿体质量、心胸面积比值、右心心肌做功指数均明显大于供血儿,差异有统计学意义(P<0.05)。(2)受血儿脐静脉频谱异常、静脉导管频谱异常、三尖瓣舒张期血流频谱异常、三尖瓣反流均明显多于供血儿,差异有统计学意义(P<0.05)。(3)受血儿中2例发生右室流出道梗阻,分别为Ⅲ级和Ⅳ级。
结论彩色多普勒超声可敏感反映TTTS受血儿心功能特别是舒张功能的异常,为判断病变的严重程度提供重要的临床信息。
目的探讨二维及彩色多普勒超声在评价双胎输血综合征(TTTS)供血儿心功能中的临床价值。
方法选择TTTS 17例及正常单绒毛膜囊双羊膜囊双胎19例,测量脐动脉、脐静脉、静脉导管等血流频谱参数,计算心胸面积比值及心肌做功指数,重点分析供血儿的心功能改变。
结果TTTS供血儿中7例出现脐动脉舒张期血流缺失或反向,1例发现心脏明显扩大并合并心包积液。供血儿静脉导管搏动指数明显高于对照组胎儿。
结论TTTS供血儿已出现一定程度的心功能异常,动态监测心功能状况有助于判断TTTS的严重程度和干预治疗的疗效。
Objective To evaluate the value of two-dimensional strain imaging in assessing right ventricular function of recipient fetus in TTTS pregnancies.
Methods This study included 16 TTTS pregnancies and 19 normal monochorionic diamniotic pregnancies(controls). Doppler studies of the umbilical artery, umbilical vein, ductus venosus, middle cerebral artery, atrioventricular valve and semilunar value were recorded in both fetus, and myocardial performance index of both ventricles was calculated. Longitudinal peak systolic strain of right ventricular were calculated and compared between recipient fetus and other fetus.
Results (1) Cardiothoracic ratio and myocardial performance index of right ventricular showed significant differences between recipient fetus and controls. (2) Right ventricular strain was decreased in recipient fetus compared with controls.
Conclusions Two-dimensional strain imaging can be uesed to evaluate right ventricular myocardial function in the recipient fetus of TTTS.
Objective To evaluate the value of color Doppler in assessing cardiac function of recipient twin in twin-twin transfusion syndrome (TTTS) pregnancies.
Methods This study included 17 TTTS pregnancies. Doppler studies of the umbilical artery, umbilical vein, ductus venosus, middle cerebral artery, atrioventricular valve and semilunar value were recorded in both fetus, and cardiothoracic ratio, heart rate, myocardial performance index of both ventricles were calculated.
Results (1)The estimated fetal weight, Cardiothoracic ratio, myocardial performance index of right ventricle in recipient twins were significant higher than that of donor twin. (2)The incidence of abnomal Doppler findings in umbilical vein, ductus venosus and tricuspid valve of recipient twin were all significantly higher than that of donor twin. (3)There were two recipient twin manifesting right ventricular outflow tract obstruction in this study.
Conclusions Color Doppler imaging can be used to evaluate cardiac dysfunction in the recipient twin.
Objective To evaluate the value of 2D and color Doppler ultrasonography in assessing cardiac function of donor fetus in twin-twin transfusion syndrome (TTTS) pregnancies.
Methods 17 TTTS pregnancies and 19 normal monochorionic diamniotic pregnancies(controls) were including in this study. To observe the cardiac funtion of donor fetus, Doppler patterns of the umbilical artery, umbilical vein, ductus venosus and myocardial performance index of both ventricles were assessed in all fetus.
Results Absent or reversed diastolic blood flow in umbilical artery were found in 7 donor fetus. One donor fetus showed increased cardiothoracic ratio and pericardial effusion. Pulsatility index of the ductus venosus in donor fetus were significant higher than that of controls.
Conclusions Mild cardiovascular abnormalities were found in donor fetus, and follow-up examination were helpful in assess the severity of this disease.
方法选择TTTS 16例及正常单绒毛膜囊双羊膜囊双胎19例,分别测量两个胎儿脐动脉、脐静脉、静脉导管、大脑中动脉、房室瓣口、半月瓣口等部位的血流频谱参数,计算心肌做功指数。然后局部放大胎儿四腔心,清晰显示心内膜及肌层,动态存储2~3个心动周期,脱机分析两组胎儿右心纵向收缩期峰值应变。
结果(1)TTTS受血儿心胸面积比值、右心心肌做功指数大于供血儿及对照组,差异有显著性意义。(2)TTTS受血儿右心游离壁、室间隔及平均纵向收缩期峰值应变小于供血儿及对照组,差异有显著性意义。
结论二维应变成像可反映TTTS受血儿的右心心肌运动异常,但是在羊水过多及胎动频繁时应用受到限制。
目的探讨彩色多普勒超声在评价双胎输血综合征受血儿心功能中的价值。
方法选择TTTS 17例,孕龄为16.4~29.2周,平均(23.2±3.4)周。常规测量胎儿双顶径、头围、腹围及股骨长;系统扫查胎儿全身结构;测量胎儿脐动脉、脐静脉、静脉导管、大脑中动脉等血流参数;测量胎儿心胸面积比值及房室瓣、半月瓣的血流参数,计算心肌做功指数。
结果(1)受血儿体质量、心胸面积比值、右心心肌做功指数均明显大于供血儿,差异有统计学意义(P<0.05)。(2)受血儿脐静脉频谱异常、静脉导管频谱异常、三尖瓣舒张期血流频谱异常、三尖瓣反流均明显多于供血儿,差异有统计学意义(P<0.05)。(3)受血儿中2例发生右室流出道梗阻,分别为Ⅲ级和Ⅳ级。
结论彩色多普勒超声可敏感反映TTTS受血儿心功能特别是舒张功能的异常,为判断病变的严重程度提供重要的临床信息。
目的探讨二维及彩色多普勒超声在评价双胎输血综合征(TTTS)供血儿心功能中的临床价值。
方法选择TTTS 17例及正常单绒毛膜囊双羊膜囊双胎19例,测量脐动脉、脐静脉、静脉导管等血流频谱参数,计算心胸面积比值及心肌做功指数,重点分析供血儿的心功能改变。
结果TTTS供血儿中7例出现脐动脉舒张期血流缺失或反向,1例发现心脏明显扩大并合并心包积液。供血儿静脉导管搏动指数明显高于对照组胎儿。
结论TTTS供血儿已出现一定程度的心功能异常,动态监测心功能状况有助于判断TTTS的严重程度和干预治疗的疗效。
Objective To evaluate the value of two-dimensional strain imaging in assessing right ventricular function of recipient fetus in TTTS pregnancies.
Methods This study included 16 TTTS pregnancies and 19 normal monochorionic diamniotic pregnancies(controls). Doppler studies of the umbilical artery, umbilical vein, ductus venosus, middle cerebral artery, atrioventricular valve and semilunar value were recorded in both fetus, and myocardial performance index of both ventricles was calculated. Longitudinal peak systolic strain of right ventricular were calculated and compared between recipient fetus and other fetus.
Results (1) Cardiothoracic ratio and myocardial performance index of right ventricular showed significant differences between recipient fetus and controls. (2) Right ventricular strain was decreased in recipient fetus compared with controls.
Conclusions Two-dimensional strain imaging can be uesed to evaluate right ventricular myocardial function in the recipient fetus of TTTS.
Objective To evaluate the value of color Doppler in assessing cardiac function of recipient twin in twin-twin transfusion syndrome (TTTS) pregnancies.
Methods This study included 17 TTTS pregnancies. Doppler studies of the umbilical artery, umbilical vein, ductus venosus, middle cerebral artery, atrioventricular valve and semilunar value were recorded in both fetus, and cardiothoracic ratio, heart rate, myocardial performance index of both ventricles were calculated.
Results (1)The estimated fetal weight, Cardiothoracic ratio, myocardial performance index of right ventricle in recipient twins were significant higher than that of donor twin. (2)The incidence of abnomal Doppler findings in umbilical vein, ductus venosus and tricuspid valve of recipient twin were all significantly higher than that of donor twin. (3)There were two recipient twin manifesting right ventricular outflow tract obstruction in this study.
Conclusions Color Doppler imaging can be used to evaluate cardiac dysfunction in the recipient twin.
Objective To evaluate the value of 2D and color Doppler ultrasonography in assessing cardiac function of donor fetus in twin-twin transfusion syndrome (TTTS) pregnancies.
Methods 17 TTTS pregnancies and 19 normal monochorionic diamniotic pregnancies(controls) were including in this study. To observe the cardiac funtion of donor fetus, Doppler patterns of the umbilical artery, umbilical vein, ductus venosus and myocardial performance index of both ventricles were assessed in all fetus.
Results Absent or reversed diastolic blood flow in umbilical artery were found in 7 donor fetus. One donor fetus showed increased cardiothoracic ratio and pericardial effusion. Pulsatility index of the ductus venosus in donor fetus were significant higher than that of controls.
Conclusions Mild cardiovascular abnormalities were found in donor fetus, and follow-up examination were helpful in assess the severity of this disease.
引文
1. Quintero RA, Morales WJ, Allen MH, et al. Staging of twin-twin transfusion syndrome. J Perinatol, 1999, 19: 550-555.
2. Ville Y. Twin-to-twin transfusion syndrome: time to forget the Quintero staging system? Ultrasound Obstet Gynecol, 2007, 30:924-927.
3. Lopriore E, Middeldorp JM, Oepkes D, et al. Twin anemia-polycythemia sequence in two monochorionic twin pairs without oligo-polyhydramnios sequence. Placenta, 2007, 28:47-51.
4. Nikkels PG, Hack KE, van Gemert MJ. Pathology of twin placentas with special attention to monochorionic twin placentas. J Clin Pathol, 2008, 61:1247-1253.
5. Fisk NM, Duncombe GJ, Sullivan MH. The basic and clinical science of twin-twin transfusion syndrome. Placenta, 2009, 30:379-390.
6. Raboisson MJ, Fouron JC, Lamoureux J, et al. Early intertwin differences in myocardial performance during the twin-to-twin transfusion syndrome. Circulation, 2004, 110:3043-3048.
7. Karatza AA, Wolfenden JL, Taylor MJ et al. Influence of twin-twin transfusion syndrome on fetal cardiovascular structure and function: prospective case-control study of 136 monochorionic twin pregnancies. Heart, 2002, 88: 271-277.
8. Barrea C, Alkazaleh F, Ryan G, et al. Prenatal cardiovascular manifestations in the twin-to-twin transfusion syndrome recipients and the impact of therapeutic amnioreduction. Am J Obstet Gynecol, 2005, 192:892-902.
9. Di Salvo G, Russo MG, Paladini D et al. Two-dimensional strain to assess regional left and right ventricular longitudinal function in 100 normal foetuses. Eur J Echocardiogr, 2008, 9:754-756.
10. Younoszai AK, Saudek DE, Emery SP, et al. Evaluation of myocardial mechanics in the fetus by velocity vector imaging. J Am Soc Echocardiogr, 2008, 21:470-474.
11. Peng QH, Zhou QC, Zeng S, et al. Evaluation of regional left ventricular longitudinal function in 151 normal fetuses using velocity vector imaging. Prenat Diagn, 2009, 29:1149-1155.
12. Barker PC, Houle H, Li JS, et al. Global longitudinal cardiac strain and strain rate for assessment of fetal cardiac function: novel experience with velocity vector imaging. Echocardiography, 2009, 26:28-36.
13. Van Mieghem T, DonéE, Gucciardo L, et al. Amniotic fluid markers of fetal cardiac dysfunction in twin-to-twin transfusion syndrome. Am J Obstet Gynecol, 2010, 202:48.e1-7.
1. Quintero RA, Morales WJ, Allen MH, et al. Staging of twin-twin transfusion syndrome. J Perinatol, 1999, 19: 550-555.
2. Ville Y. Twin-to-twin transfusion syndrome: time to forget the Quintero staging system? Ultrasound Obstet Gynecol, 2007, 30(7):924-927.
3. Lopriore E, Middeldorp JM, Oepkes D, et al. Twin anemia-polycythemia sequence in two monochorionic twin pairs without oligo-polyhydramnios sequence. Placenta, 2007, 28:47-51.
4. Nikkels PG, Hack KE, van Gemert MJ. Pathology of twin placentas with special attention to monochorionic twin placentas. J Clin Pathol, 2008, 61:1247-1253.
5. Fisk NM, Duncombe GJ, Sullivan MH. The basic and clinical science of twin-twin transfusion syndrome. Placenta, 2009, 30:379-390.
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7. Barrea C, Alkazaleh F, Ryan G, et al. Prenatal cardiovascular manifestations in the twin-to-twin transfusion syndrome recipients and the impact of therapeutic amnioreduction. Am J Obstet Gynecol, 2005, 192:892-902.
8. Raboisson MJ, Fouron JC, Lamoureux J, et al. Early intertwin differences in myocardial performance during the twin-to-twin transfusion syndrome. Circulation, 2004, 110:3043-3048.
9. Rychik J, Tian Z, Bebbington M, et al. The twin-twin transfusion syndrome: spectrum of cardiovascular abnormality and development of a cardiovascular score to assess severity of disease. Am J Obstet Gynecol, 2007, 197(4):392.e1-8.
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11. Habli M, Michelfelder E, Livingston J, et al. Acute effects of selective fetoscopic laser photocoagulation on recipient cardiac function in twin-twin transfusion syndrome. Am J Obstet Gynecol, 2008, 199:4121-4126.
12. Lougheed J, Sinclair BG, Fung Kee Fung K, et al. Acquired right ventricular outflow tract obstruction in the recipient twin in twin-twin transfusion syndrome. J Am Coll Cardiol, 2001, 38:1533-1538.
1. Barrea C, Alkazaleh F, Ryan G, et al. Prenatal cardiovascular manifestations in the twin-to-twin transfusion syndrome recipients and the impact of therapeutic amnioreduction. Am J Obstet Gynecol, 2005, 192:892-902.
2. Lougheed J, Sinclair BG, Fung Kee Fung K, et al. Acquired right ventricular outflow tract obstruction in the recipient twin in twin-twin transfusion syndrome. J Am Coll Cardiol, 2001, 38:1533-1538.
3. Quintero RA, Morales WJ, Allen MH, et al. Staging of twin-twin transfusion syndrome. J Perinatol, 1999, 19: 550-555.
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8. Michelfelder E, Gottliebson W, Border W, et al. Early manifestations and spectrum of recipient twin cardiomyopathy in twin-twin transfusion syndrome: relation to Quintero stage. Ultrasound Obstet Gynecol, 2007, 30:965-971.
9. Rychik J, Tian Z, Bebbington M, et al. The twin-twin transfusion syndrome: spectrum of cardiovascular abnormality and development of a cardiovascular score to assess severity of disease. Am J Obstet Gynecol, 2007, 197:392.e1-8.
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14. Rychik J, Tian Z, Bebbington M, et al. The twin-twin transfusion syndrome: spectrum of cardiovascular abnormality and development of a cardiovascular score to assess severity of disease. Am J Obstet Gynecol, 2007, 197:392.e1-8.
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1. Barrea C, Alkazaleh F, Ryan G, McCrindle BW, Roberts A, Bigras JL, Barrett J, Seaward GP, Smallhorn JF, Hornberger LK. Prenatal cardiovascular manifestations in the twin-to-twin transfusion syndrome recipients and the impact of therapeutic amnioreduction. Am J Obstet Gynecol 2005; 192: 892-902.
2. Rychik J, Tian Z, Bebbington M, Xu F, McCann M, Mann S, Wilson RD, Johnson MP. The twin-twin transfusion syndrome: spectrum of cardiovascular abnormality and development of a cardiovascular score to assess severity of disease. Am J Obstet Gynecol 2007; 197: 392.e1-e8.
3. Di Salvo G, Russo MG, Paladini D, Felicetti M, Castaldi B, Tartaglione A, di Pietto L, Ricci C, Morelli C, Pacileo G, CalabròR. Two-dimensional strain to assess regional left and right ventricular longitudinal function in 100 normal foetuses. Eur J Echocardiogr 2008; 9: 754-756.
4. Barker PC, Houle H, Li JS, Miller S, Herlong JR, Camitta MG. Global longitudinal cardiac strain and strain rate for assessment of fetal cardiac function: novel experience with velocity vector imaging. Echocardiography 2009 ; 26: 28-36.
5. Quintero RA, Morales WJ, Allen MH, Bornick PW, Johnson PK, Kruger M. Staging of twin-twin transfusion syndrome. J Perinatol 1999; 19: 550-555.
6. International Society of Ultrasound in Obstetrics & Gynecology. Cardiac screening examination of the fetus: guidelines for performing the 'basic' and 'extended basic' cardiac scan. Ultrasound Obstet Gynecol 2006; 27: 107-113.
7. Fisk NM, Duncombe GJ, Sullivan MH. The basic and clinical science of twin-twin transfusion syndrome. Placenta 2009; 30: 379-390.
8. Nikkels PG, Hack KE, van Gemert MJ. Pathology of twin placentas with special attention to monochorionic twin placentas. J Clin Pathol 2008; 61: 1247-1253.
9. Barrea C, Hornberger LK, Alkazaleh F, McCrindle BW, Roberts A, Berezovska O, Windrim R, Seaward PG, Smallhorn JF, Ryan G. Impact of selective laser ablation of placental anastomoses on the cardiovascular pathology of the recipient twin in severe twin-twin transfusion syndrome. Am J Obstet Gynecol 2006; 195: 1388-1395.
10. Michelfelder E, Gottliebson W, Border W, Kinsel M, Polzin W, Livingston J, Khoury P, Crombleholme T. Early manifestations and spectrum of recipient twin cardiomyopathy in twin-twin transfusion syndrome: relation to Quintero stage. Ultrasound Obstet Gynecol 2007; 30: 965-971.
11. Raboisson MJ, Fouron JC, Lamoureux J, Leduc L, Grignon A, Proulx F, Gamache S. Early intertwin differences in myocardial performance during the twin-to-twin transfusion syndrome. Circulation 2004; 110: 3043-3048.
12. Van Mieghem T, DeKoninck P, Steenhaut P, Deprest J. Methods for prenatal assessment of fetal cardiac function. Prenat Diagn 2009; 29:1193-1203.
13. Jack Rychik. Impact of anomalies other than congenital heart disease on the fetal cardiovascular system. Prog Pediatr Cardiol 2006; 22:109-119.
14. Younoszai AK, Saudek DE, Emery SP, Thomas JD. Evaluation of myocardial mechanics in the fetus by velocity vector imaging. J Am Soc Echocardiogr 2008; 21: 470-474.
15. Peng QH, Zhou QC, Zeng S, Tian LQ, Zhang M, Tan Y, Pu DR. Evaluation of regional left ventricular longitudinal function in 151 normal fetuses using velocity vector imaging. Prenat Diagn 2009 ; 29: 1149-1155.
16. Van Mieghem T, Giusca S, DeKoninck P, Gucciardo L, DonéE, Hindryckx A, D'Hooge J, Deprest J. Prospective assessment of fetal cardiac function with speckle tracking in healthy fetuses and recipient fetuses of twin-to-twin transfusion syndrome. J Am Soc Echocardiogr 2010 ; 23: 301-308.
[1] Kusanovic J, Romero R, Espinoza J, et al. Twin-to-twin transfusion syndrome: an antiangiogenic state? Am J Obstet Gynecol, 2008, 198(4):382.e1-8.
[2] Galea P, Jain V, Fisk NM. Insights into the pathophysiology of twin-twin transfusion syndrome. Prenat Diagn, 2005, 25(9):777-785.
[3] Rychik J, Tian Z, Bebbington M, et al. The twin-twin transfusion syndrome: spectrum of cardiovascular abnormality and development of a cardiovascular score to assess severity of disease. Am J Obstet Gynecol, 2007, 197(4):392.e1-8.
[4] Quintero RA, Morales WJ, Allen MH, et al. Staging of twin-twin transfusion syndrome. J Perinatol, 1999, 19(8 Pt 1):550-555.
[5] Fisk NM, Duncombe GJ, Sullivan MH. The basic and clinical science of twin-twin transfusion syndrome. Placenta, 2009, 30(5):379-390.
[6] Ville Y. Twin-to-twin transfusion syndrome: time to forget the Quintero staging system? Ultrasound Obstet Gynecol, 2007, 30(7):924-927.
[7] Michelfelder E, Gottliebson W, Border W, et al. Early manifestations and spectrum of recipient twin cardiomyopathy in twin-twin transfusion syndrome: relation to Quintero stage. Ultrasound Obstet Gynecol, 2007, 30(7):965-971.
[8] Nikkels PG, Hack KE, van Gemert MJ. Pathology of twin placentas with special attention to monochorionic twin placentas. J Clin Pathol, 2008, 61(12):1247-1253.
[9] Barrea C, Alkazaleh F, Ryan G, et al. Prenatal cardiovascular manifestations in the twin-to-twin transfusion syndrome recipients and the impact of therapeutic amnioreduction. Am J Obstet Gynecol, 2005, 192(3):892-902.
[10] Lougheed J, Sinclair BG, Fung Kee Fung K, et al. Acquired right ventricular outflow tract obstruction in the recipient twin in twin-twin transfusion syndrome. J Am Coll Cardiol, 2001, 38(5):1533-1538.
2. Ville Y. Twin-to-twin transfusion syndrome: time to forget the Quintero staging system? Ultrasound Obstet Gynecol, 2007, 30:924-927.
3. Lopriore E, Middeldorp JM, Oepkes D, et al. Twin anemia-polycythemia sequence in two monochorionic twin pairs without oligo-polyhydramnios sequence. Placenta, 2007, 28:47-51.
4. Nikkels PG, Hack KE, van Gemert MJ. Pathology of twin placentas with special attention to monochorionic twin placentas. J Clin Pathol, 2008, 61:1247-1253.
5. Fisk NM, Duncombe GJ, Sullivan MH. The basic and clinical science of twin-twin transfusion syndrome. Placenta, 2009, 30:379-390.
6. Raboisson MJ, Fouron JC, Lamoureux J, et al. Early intertwin differences in myocardial performance during the twin-to-twin transfusion syndrome. Circulation, 2004, 110:3043-3048.
7. Karatza AA, Wolfenden JL, Taylor MJ et al. Influence of twin-twin transfusion syndrome on fetal cardiovascular structure and function: prospective case-control study of 136 monochorionic twin pregnancies. Heart, 2002, 88: 271-277.
8. Barrea C, Alkazaleh F, Ryan G, et al. Prenatal cardiovascular manifestations in the twin-to-twin transfusion syndrome recipients and the impact of therapeutic amnioreduction. Am J Obstet Gynecol, 2005, 192:892-902.
9. Di Salvo G, Russo MG, Paladini D et al. Two-dimensional strain to assess regional left and right ventricular longitudinal function in 100 normal foetuses. Eur J Echocardiogr, 2008, 9:754-756.
10. Younoszai AK, Saudek DE, Emery SP, et al. Evaluation of myocardial mechanics in the fetus by velocity vector imaging. J Am Soc Echocardiogr, 2008, 21:470-474.
11. Peng QH, Zhou QC, Zeng S, et al. Evaluation of regional left ventricular longitudinal function in 151 normal fetuses using velocity vector imaging. Prenat Diagn, 2009, 29:1149-1155.
12. Barker PC, Houle H, Li JS, et al. Global longitudinal cardiac strain and strain rate for assessment of fetal cardiac function: novel experience with velocity vector imaging. Echocardiography, 2009, 26:28-36.
13. Van Mieghem T, DonéE, Gucciardo L, et al. Amniotic fluid markers of fetal cardiac dysfunction in twin-to-twin transfusion syndrome. Am J Obstet Gynecol, 2010, 202:48.e1-7.
1. Quintero RA, Morales WJ, Allen MH, et al. Staging of twin-twin transfusion syndrome. J Perinatol, 1999, 19: 550-555.
2. Ville Y. Twin-to-twin transfusion syndrome: time to forget the Quintero staging system? Ultrasound Obstet Gynecol, 2007, 30(7):924-927.
3. Lopriore E, Middeldorp JM, Oepkes D, et al. Twin anemia-polycythemia sequence in two monochorionic twin pairs without oligo-polyhydramnios sequence. Placenta, 2007, 28:47-51.
4. Nikkels PG, Hack KE, van Gemert MJ. Pathology of twin placentas with special attention to monochorionic twin placentas. J Clin Pathol, 2008, 61:1247-1253.
5. Fisk NM, Duncombe GJ, Sullivan MH. The basic and clinical science of twin-twin transfusion syndrome. Placenta, 2009, 30:379-390.
6. DeVore GR. Assessing fetal cardiac ventricular function. Semin Fetal Neonatal Med, 2005, 10(6):515-541.
7. Barrea C, Alkazaleh F, Ryan G, et al. Prenatal cardiovascular manifestations in the twin-to-twin transfusion syndrome recipients and the impact of therapeutic amnioreduction. Am J Obstet Gynecol, 2005, 192:892-902.
8. Raboisson MJ, Fouron JC, Lamoureux J, et al. Early intertwin differences in myocardial performance during the twin-to-twin transfusion syndrome. Circulation, 2004, 110:3043-3048.
9. Rychik J, Tian Z, Bebbington M, et al. The twin-twin transfusion syndrome: spectrum of cardiovascular abnormality and development of a cardiovascular score to assess severity of disease. Am J Obstet Gynecol, 2007, 197(4):392.e1-8.
10. Stirnemann JJ, Mougeot M, Proulx F, et al. Profiling fetal cardiac function in twin-twin transfusion syndrome. Ultrasound Obstet Gynecol, 2010, 35(1):19-27.
11. Habli M, Michelfelder E, Livingston J, et al. Acute effects of selective fetoscopic laser photocoagulation on recipient cardiac function in twin-twin transfusion syndrome. Am J Obstet Gynecol, 2008, 199:4121-4126.
12. Lougheed J, Sinclair BG, Fung Kee Fung K, et al. Acquired right ventricular outflow tract obstruction in the recipient twin in twin-twin transfusion syndrome. J Am Coll Cardiol, 2001, 38:1533-1538.
1. Barrea C, Alkazaleh F, Ryan G, et al. Prenatal cardiovascular manifestations in the twin-to-twin transfusion syndrome recipients and the impact of therapeutic amnioreduction. Am J Obstet Gynecol, 2005, 192:892-902.
2. Lougheed J, Sinclair BG, Fung Kee Fung K, et al. Acquired right ventricular outflow tract obstruction in the recipient twin in twin-twin transfusion syndrome. J Am Coll Cardiol, 2001, 38:1533-1538.
3. Quintero RA, Morales WJ, Allen MH, et al. Staging of twin-twin transfusion syndrome. J Perinatol, 1999, 19: 550-555.
4. Shetty A, Smith AP. The sonographic diagnosis of chorionicity. Prenat Diagn, 2005, 25:735-739.
5. International Society of Ultrasound in Obstetrics & Gynecology. Cardiac screening examination of the fetus: guidelines for performing the 'basic' and 'extended basic' cardiac scan. Ultrasound Obstet Gynecol, 2006, 27:107-113.
6. Acharya G, Pavlovic M, Ewing L, et al. Comparison between pulsed-wave Doppler- and tissue Doppler-derived Tei indices in fetuses with and without congenital heart disease. Ultrasound Obstet Gynecol, 2008, 31:406-411.
7. Fisk NM, Duncombe GJ, Sullivan MH. The basic and clinical science of twin-twin transfusion syndrome. Placenta, 2009, 30:379-390.
8. Michelfelder E, Gottliebson W, Border W, et al. Early manifestations and spectrum of recipient twin cardiomyopathy in twin-twin transfusion syndrome: relation to Quintero stage. Ultrasound Obstet Gynecol, 2007, 30:965-971.
9. Rychik J, Tian Z, Bebbington M, et al. The twin-twin transfusion syndrome: spectrum of cardiovascular abnormality and development of a cardiovascular score to assess severity of disease. Am J Obstet Gynecol, 2007, 197:392.e1-8.
10. Bahtiyar MO, Copel JA. Cardiac changes in the intrauterine growth-restr -icted fetus. Semin Perinatol, 2008, 32:190-193.
11. Crispi F, Hernandez-Andrade E, Pelsers MM, et al. Cardiac dysfunction and cell damage across clinical stages of severity in growth-restricted fetuses. Am J Obstet Gynecol, 2008, 199:254.e1-8.
12. Karatza AA, Wolfenden JL, Taylor MJ et al. Influence of twin-twin transfusion syndrome on fetal cardiovascular structure and function: prospective case-control study of 136 monochorionic twin pregnancies. Heart, 2002, 88: 271-277.
13. Michelfelder E. Doppler echocardiographic characterization of the fetus in distress. Prog Pediatr Cardiol, 2006, 22;31-39.
14. Van Mieghem T, Klaritsch P, DonéE, et al. Assessment of fetal cardiac function before and after therapy for twin-to-twin transfusion syndrome. Am J Obstet Gynecol, 2009, 200:400.e1-7.
1. Galea P, Jain V, Fisk NM. Insights into the pathophysiology of twin-twin transfusion syndrome. Prenat Diagn, 2005, 25:777-785.
2. Hack KE, Nikkels PG, Koopman-Esseboom C, et al. Placental characteristics of monochorionic diamniotic twin pregnancies in relation to perinatal outcome. Placenta, 2008, 29:976-981.
3. Nikkels PG, Hack KE, van Gemert MJ. Pathology of twin placentas with special attention to monochorionic twin placentas. J Clin Pathol, 2008, 61:1247-1253.
4. Quintero RA, Morales WJ, Allen MH, et al. Staging of twin-twin transfusion syndrome. J Perinatol, 1999, 19:550-555.
5. Ville Y. Twin-to-twin transfusion syndrome: time to forget the Quintero staging system? Ultrasound Obstet Gynecol, 2007, 30:924-927.
6. Fisk NM, Duncombe GJ, Sullivan MH. The basic and clinical science of twin-twin transfusion syndrome. Placenta, 2009, 30:379-390.
7. Lopriore E, Middeldorp JM, Oepkes D, et al. Twin anemia-polycythemia sequence in two monochorionic twin pairs without oligo-polyhydramnios sequence. Placenta, 2007, 28:47-51.
8. Russell Z, Quintero RA, Kontopoulos EV. What is the definition of pulsatile umbilical venous flow in twin-twin transfusion syndrome? Am J Obstet Gynecol, 2008, 199:634.e1-e4.
9. Michelfelder E, Gottliebson W, Border W, et al. Early manifestations and spectrum of recipient twin cardiomyopathy in twin-twin transfusion syndrome: relation to Quintero stage. Ultrasound Obstet Gynecol, 2007, 30:965-971.
10. Barrea C, Alkazaleh F, Ryan G, et al. Prenatal cardiovascular manifestations in the twin-to-twin transfusion syndrome recipients and the impact of therapeutic amnioreduction. Am J Obstet Gynecol, 2005, 192:892-902.
11. Szwast A, Tian Z, McCann M, et al. Impact of altered loading conditions on ventricular performance in fetuses with congenital cystic adenomatoid malformation and twin-twin transfusion syndrome. Ultrasound Obstet Gynecol, 2007, 30:40-46.
12. Sueters M, Middeldorp JM, Lopriore E, et al. Fetal cardiac output in monochorionic twins. Ultrasound Obstet Gynecol, 2008, 32:807-812.
13. Raboisson MJ, Fouron JC, Lamoureux J, et al. Early intertwin differences in myocardial performance during the twin-to-twin transfusion syndrome. Circulation, 2004, 110:3043-3048.
14. Rychik J, Tian Z, Bebbington M, et al. The twin-twin transfusion syndrome: spectrum of cardiovascular abnormality and development of a cardiovascular score to assess severity of disease. Am J Obstet Gynecol, 2007, 197:392.e1-8.
15. Lougheed J, Sinclair BG, Fung Kee Fung K, et al. Acquired right ventricular outflow tract obstruction in the recipient twin in twin-twin transfusion syndrome. J Am Coll Cardiol, 2001, 38:1533-1538.
16. Rossi AC, D'Addario V. Laser therapy and serial amnioreduction as treatment for twin-twin transfusion syndrome: a metaanalysis and review of literature. Am J Obstet Gynecol, 2008, 198:147-152.
17. Roberts D, Gates S, Kilby M, et al. Interventions for twin-twin transfusion syndrome: a Cochrane review. Ultrasound Obstet Gynecol, 2008, 31:701-711.
18. Herberg U, Gross W, Bartmann P, et al. Long term cardiac follow up of severe twin to twin transfusion syndrome after intrauterine laser coagulation. Heart, 2006, 92:95-100.
19. Habli M, Michelfelder E, Livingston J, et al. Acute effects of selective fetoscopic laser photocoagulation on recipient cardiac function in twin-twin transfusion syndrome. Am J Obstet Gynecol, 2008, 199: 412.e1-e6.
20. Van Mieghem T, Klaritsch P, DonéE, et al. Assessment of fetal cardiac function before and after therapy for twin-to-twin transfusion syndrome. Am J Obstet Gynecol, 2009, 200:400.e1-400.e7.
21. Ishii K, Chmait RH, Martínez JM, et al. Ultrasound assessment of venous blood flow before and after laser therapy: approach to understanding the pathophysiology of twin-twin transfusion syndrome. Ultrasound Obstet Gynecol, 2004, 24:164-168.
22. Yamamoto M, Nasr B, Ortqvist L, et al. Intertwin discordance in umbilical venous volume flow: a reflection of blood volume imbalance in twin-to-twin transfusion syndrome. Ultrasound Obstet Gynecol, 2007, 29:317-320.
1. Barrea C, Alkazaleh F, Ryan G, McCrindle BW, Roberts A, Bigras JL, Barrett J, Seaward GP, Smallhorn JF, Hornberger LK. Prenatal cardiovascular manifestations in the twin-to-twin transfusion syndrome recipients and the impact of therapeutic amnioreduction. Am J Obstet Gynecol 2005; 192: 892-902.
2. Rychik J, Tian Z, Bebbington M, Xu F, McCann M, Mann S, Wilson RD, Johnson MP. The twin-twin transfusion syndrome: spectrum of cardiovascular abnormality and development of a cardiovascular score to assess severity of disease. Am J Obstet Gynecol 2007; 197: 392.e1-e8.
3. Di Salvo G, Russo MG, Paladini D, Felicetti M, Castaldi B, Tartaglione A, di Pietto L, Ricci C, Morelli C, Pacileo G, CalabròR. Two-dimensional strain to assess regional left and right ventricular longitudinal function in 100 normal foetuses. Eur J Echocardiogr 2008; 9: 754-756.
4. Barker PC, Houle H, Li JS, Miller S, Herlong JR, Camitta MG. Global longitudinal cardiac strain and strain rate for assessment of fetal cardiac function: novel experience with velocity vector imaging. Echocardiography 2009 ; 26: 28-36.
5. Quintero RA, Morales WJ, Allen MH, Bornick PW, Johnson PK, Kruger M. Staging of twin-twin transfusion syndrome. J Perinatol 1999; 19: 550-555.
6. International Society of Ultrasound in Obstetrics & Gynecology. Cardiac screening examination of the fetus: guidelines for performing the 'basic' and 'extended basic' cardiac scan. Ultrasound Obstet Gynecol 2006; 27: 107-113.
7. Fisk NM, Duncombe GJ, Sullivan MH. The basic and clinical science of twin-twin transfusion syndrome. Placenta 2009; 30: 379-390.
8. Nikkels PG, Hack KE, van Gemert MJ. Pathology of twin placentas with special attention to monochorionic twin placentas. J Clin Pathol 2008; 61: 1247-1253.
9. Barrea C, Hornberger LK, Alkazaleh F, McCrindle BW, Roberts A, Berezovska O, Windrim R, Seaward PG, Smallhorn JF, Ryan G. Impact of selective laser ablation of placental anastomoses on the cardiovascular pathology of the recipient twin in severe twin-twin transfusion syndrome. Am J Obstet Gynecol 2006; 195: 1388-1395.
10. Michelfelder E, Gottliebson W, Border W, Kinsel M, Polzin W, Livingston J, Khoury P, Crombleholme T. Early manifestations and spectrum of recipient twin cardiomyopathy in twin-twin transfusion syndrome: relation to Quintero stage. Ultrasound Obstet Gynecol 2007; 30: 965-971.
11. Raboisson MJ, Fouron JC, Lamoureux J, Leduc L, Grignon A, Proulx F, Gamache S. Early intertwin differences in myocardial performance during the twin-to-twin transfusion syndrome. Circulation 2004; 110: 3043-3048.
12. Van Mieghem T, DeKoninck P, Steenhaut P, Deprest J. Methods for prenatal assessment of fetal cardiac function. Prenat Diagn 2009; 29:1193-1203.
13. Jack Rychik. Impact of anomalies other than congenital heart disease on the fetal cardiovascular system. Prog Pediatr Cardiol 2006; 22:109-119.
14. Younoszai AK, Saudek DE, Emery SP, Thomas JD. Evaluation of myocardial mechanics in the fetus by velocity vector imaging. J Am Soc Echocardiogr 2008; 21: 470-474.
15. Peng QH, Zhou QC, Zeng S, Tian LQ, Zhang M, Tan Y, Pu DR. Evaluation of regional left ventricular longitudinal function in 151 normal fetuses using velocity vector imaging. Prenat Diagn 2009 ; 29: 1149-1155.
16. Van Mieghem T, Giusca S, DeKoninck P, Gucciardo L, DonéE, Hindryckx A, D'Hooge J, Deprest J. Prospective assessment of fetal cardiac function with speckle tracking in healthy fetuses and recipient fetuses of twin-to-twin transfusion syndrome. J Am Soc Echocardiogr 2010 ; 23: 301-308.
[1] Kusanovic J, Romero R, Espinoza J, et al. Twin-to-twin transfusion syndrome: an antiangiogenic state? Am J Obstet Gynecol, 2008, 198(4):382.e1-8.
[2] Galea P, Jain V, Fisk NM. Insights into the pathophysiology of twin-twin transfusion syndrome. Prenat Diagn, 2005, 25(9):777-785.
[3] Rychik J, Tian Z, Bebbington M, et al. The twin-twin transfusion syndrome: spectrum of cardiovascular abnormality and development of a cardiovascular score to assess severity of disease. Am J Obstet Gynecol, 2007, 197(4):392.e1-8.
[4] Quintero RA, Morales WJ, Allen MH, et al. Staging of twin-twin transfusion syndrome. J Perinatol, 1999, 19(8 Pt 1):550-555.
[5] Fisk NM, Duncombe GJ, Sullivan MH. The basic and clinical science of twin-twin transfusion syndrome. Placenta, 2009, 30(5):379-390.
[6] Ville Y. Twin-to-twin transfusion syndrome: time to forget the Quintero staging system? Ultrasound Obstet Gynecol, 2007, 30(7):924-927.
[7] Michelfelder E, Gottliebson W, Border W, et al. Early manifestations and spectrum of recipient twin cardiomyopathy in twin-twin transfusion syndrome: relation to Quintero stage. Ultrasound Obstet Gynecol, 2007, 30(7):965-971.
[8] Nikkels PG, Hack KE, van Gemert MJ. Pathology of twin placentas with special attention to monochorionic twin placentas. J Clin Pathol, 2008, 61(12):1247-1253.
[9] Barrea C, Alkazaleh F, Ryan G, et al. Prenatal cardiovascular manifestations in the twin-to-twin transfusion syndrome recipients and the impact of therapeutic amnioreduction. Am J Obstet Gynecol, 2005, 192(3):892-902.
[10] Lougheed J, Sinclair BG, Fung Kee Fung K, et al. Acquired right ventricular outflow tract obstruction in the recipient twin in twin-twin transfusion syndrome. J Am Coll Cardiol, 2001, 38(5):1533-1538.