Tissue Doppler Analysis of Postnatal Circulatory Dysfunction in Recipient Infants of Twin-Twin Transfusion Syndrome

Background: A recipient infant of twin-twin transfusion syndrome (TTTS) may often suffer from severe circulatory dysfunction postnatally, but an adequate method that can assess early cardiac failure has not been established. Objectives: To examine the clinical utility of tissue Doppler imaging (TDI) echocardiography for management of circulatory dysfunction in preterm TTTS. Methods: Out of 172 very low birth weight (VLBW) infants admitted from 2004 to 2007, five recipient infants of monochorionic diamniotic twins were defined as recipient group (n=5). Three to five control infants matched for gestational age, birth weight, gender were selected from the remaining VLBW infants in the same study period (control group, n=20). Serial echocardiographic examinations including TDI were performed from birth to days 7, then peak systolic velocities (S), early diastolic velocities (Ea), late diastolic velocities (Aa), and myocardial performance index (MPI) were measured at the lateral annulus of mitral and tricuspid valves. Results: There were no significant differences in longitudinal changes of mitral S, Ea, Aa. Values of left ventricular MPIs assessed by TDI in the recipient group before 24 hours after birth appeared to be significantly higher than those in the control group. Early values of tricuspid S and Ea values in the recipients significantly decreased compared to those in the controls. Right ventricular MPIs of recipient infants before 24 hours were also significantly higher than those in the control infants. Conclusions: These preliminary comparisons suggested that early circulatory disturbances of the recipient infants with preterm TTTS might be accurately assessed by TDI.