Amniotic fluid markers of fetal cardiac dysfunction in twin-to-twin transfusion syndrome

作者：Van Mieghem Tim^*; Done Elisa; Gucciardo Leonardo; Klaritsch Philipp; Allegaert Karel; Van Bree Rita; Lewi Lie**eth; Deprest Jan

来源：American Journal of Obstetrics and Gynecology, 2010, 202(1): 48.e1.

DOI：10.1016/j.ajog.2009.08.013

• echocardiography
• fetal surgery
• natriuretic peptide
• troponin
• twin-to-twin transfusion

OBJECTIVE: The objective of the study was to determine whether cardiac troponin T (cTnT) and natriuretic peptides can be isolated from the amniotic fluid (AF) of pregnancies complicated by twin-to-twin transfusion syndrome (TTTS) and whether they correlate with fetal echocardiographic findings and recipient survival.
STUDY DESIGN: AF samples from the recipient sac were obtained in 52 TTTS cases and 16 controls. Samples were assayed for cTnT and natriuretic peptides. Prior to fetoscopic laser therapy, 34 recipient twins underwent assessment of atrioventricular flow patterns, myocardial performance index (MPI), and precordial venous Dopplers. Fetal survival was assessed 48 hours postoperatively.
RESULTS: AF B-type natriuretic peptide and cTnT levels were elevated in TTTS and correlated with functional echocardiographic findings. Postoperative recipient survival was 72% when both AF-cTnT and left ventricular MPI were increased. If 1 of both markers was normal, survival was 100% (P = .046).
CONCLUSION: Combining ultrasound and AF-cTnT measurements allows the identification of fetuses at risk of postoperative demise.

• 出版日期2010-1