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© 2006 by the American Institute of Ultrasound in Medicine
J Ultrasound Med 25:455-459 • 0278-4297

Fetal Echocardiographic Findings Are Not Predictive of Death in Twin-Twin Transfusion Syndrome

Brenna L. Anderson, MD, Frederick S. Sherman, MD, Fulvia Mancini, MD and Hyagiv N. Simhan, MD, MS

Departments of Obstetrics, Gynecology, and Reproductive Sciences (B.L.A., F.M., H.N.S.), Pediatrics (F.S.S.), and Cardiology (F.S.S.), Magee-Womens Hospital, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania USA.

Address correspondence to Brenna L. Anderson, MD, Division of Maternal-Fetal Medicine, Magee-Womens Hospital, University of Pittsburgh, 300 Halket St, Pittsburgh, PA 15213 USA. E-mail: banderson{at}mail.magee.edu

Objective. The purpose of this study was to determine whether fetal echocardiographic findings are predictive of prognosis in recipient fetuses with twin-twin transfusion syndrome (TTTS). Methods. A cohort of 30 pregnancies with TTTS between 1990 and 2001 was included. Diagnosis and staging of TTTS were made according to the Quintero system. Fetal echocardiographic findings of cardiomegaly, right ventricular hypertrophy, and tricuspid regurgitation were evaluated for relationship with fetal death. Power analysis revealed an approximately 80% power to detect a 2-fold increased risk of fetal death, with {alpha} = .05. Logistic regression was used to determine the relationship between echocardiographic findings and death. Results. Most pregnancies were Quintero stage 1, n = 13 (43%), and ranged in severity to Quintero stage 5, n = 4 (13%). Cardiac findings in the recipient fetus that were assessed for a relationship with death included cardiomegaly at the initial appearance of TTTS or at the most severe evaluation findings, right ventricular hypertrophy at initial appearance or at the most severe evaluation findings, or tricuspid regurgitation at initial appearance or at the most severe evaluation findings. Fetal or neonatal death in the recipient twin was not related to the presence of cardiac findings (odds ratio, 0.77; 95% confidence interval, 0.16–3.74). Conclusions. Fetal echocardiographic findings, whether evaluated at initial appearance or over the course of serial evaluations, were not related to fetal or neonatal death in recipient twins with TTTS.

Key Words: fetal echocardiogram • prognosis • staging • twin-twin transfusion syndrome

Abbreviations: TTTS, twin-twin transfusion syndrome

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Copyright © 2006 by the American Institute of Ultrasound in Medicine.