Congenital heart disease in twin-to-twin transfusion syndrome treated with fetoscopic laser surgery

Congenit Heart Dis. 2007 Jan-Feb;2(1):38-43. doi: 10.1111/j.1747-0803.2007.00070.x.


Objective: To determine the incidence of congenital heart disease (CHD) and right ventricular outflow tract obstruction (RVOTO) in twin-to-twin transfusion syndrome (TTTS) treated with fetoscopic laser surgery and evaluate the role of increased afterload by determining the difference in blood pressure and endothelin-1 at birth between donor and recipient twins.

Design: Prospective study.

Setting: Tertiary medical center, serving as the national referral center for fetoscopic laser surgery for TTTS in The Netherlands.

Patients: All consecutive cases of monochorionic twins with TTTS treated with laser (n = 46 twin pairs) and monochorionic twins without TTTS (n = 55 twin pairs) delivered at our center between June 2002 and June 2005 were included in the study.

Interventions: Echocardiography was performed within 1 week after delivery. At birth, blood pressure was measured in all survivors and endothelin-1 was determined in umbilical cord blood. Data on RVOTO in TTTS treated with laser surgery at our center but delivered elsewhere were reviewed retrospectively from medical records.

Results: The incidence of CHD in the TTTS group and non-TTTS group was 5.4% (4/74) and 2.3% (2/87) (P = .42), respectively. RVOTO was diagnosed in 1 recipient twin delivered at our center and 2 recipient twins delivered elsewhere. The incidence of RVOTO in recipients was 4% (3/75). Mean systolic blood pressure at birth was similar in donor and recipient twins, respectively, 53 mm Hg vs. 56 mm Hg (P = .42). Mean endothelin-1 level at birth was also similar between donors and recipients, respectively, 14.3 ng/L and 13.2 ng/L (P = .64).

Conclusion: The incidence of CHD in TTTS treated with fetoscopic laser surgery is higher than in the general population (5.4% vs. 0.5%). We found no difference in afterload parameters between donors and recipients after laser treatment.

Publication types

  • Comparative Study

MeSH terms

  • Blood Pressure
  • Diseases in Twins
  • Echocardiography
  • Endothelin-1 / blood
  • Female
  • Fetofetal Transfusion / complications*
  • Fetoscopy*
  • Heart Defects, Congenital / complications
  • Heart Defects, Congenital / physiopathology
  • Heart Defects, Congenital / surgery*
  • Humans
  • Infant, Newborn
  • Laser Therapy / methods*
  • Male
  • Pregnancy
  • Prospective Studies
  • Treatment Outcome
  • Ventricular Outflow Obstruction / complications
  • Ventricular Outflow Obstruction / diagnostic imaging
  • Ventricular Outflow Obstruction / surgery*


  • Endothelin-1