Rychik et al reported a cardiovascular score for fetuses with the twin-twin transfusion syndrome (TTTS). This can help to identify the cardiac abnormalities that may be seen in the recipient fetus. The authors are from Children's Hospital of Philadelphia and University of Pennsylvania.
Patient selection: pregnancy with twin-twin syndrome
Analysis: Doppler ultrasonography
Parameters:
(1) umbilical artery blood flow in donor fetus
(2) ventricular hypertrophy in recipient fetus
(3) cardiac dilation in recipient fetus
(4) ventricular dysfunction in recipient fetus
(5) tricuspid valve regurgitation (TVR) in recipient fetus
(6) mitral valve regurgitation (MVR) in recipient fetus
(7) tricuspid valve (TV) inflow in recipient fetus
(8) mitral valve (MV) inflow in recipient fetus
(9) ductus venosus blood flow in recipient fetus
(10) umbilical vein pulsations in recipient fetus
(11) right-sided outflow tract in recipient fetus
(12) pulmonary valve regurgitation (PVR) in recipient fetus
|
Parameter |
Finding |
Points |
|
umbilical artery blood flow in donor |
normal |
0 |
|
|
decreased diastolic |
1 |
|
|
absent or reversed diastolic blood flow |
2 |
|
ventricular hypertrophy in recipient |
none |
0 |
|
|
present |
1 |
|
cardiac dilation in recipient |
none |
0 |
|
|
mild |
1 |
|
|
moderate or severe |
2 |
|
ventricular dysfunction in recipient |
none |
0 |
|
|
mild |
1 |
|
|
moderate or severe |
|
|
TVR in recipient |
none |
0 |
|
|
mild |
1 |
|
|
moderate or severe |
2 |
|
MVR in recipient |
none |
0 |
|
|
mild |
1 |
|
|
moderate or severe |
2 |
|
TV inflow in recipient |
double-peak |
0 |
|
|
single peak |
1 |
|
MV inflow in recipient |
double-peak |
0 |
|
|
single peak |
1 |
|
ductus venosus in recipient |
all antegrade |
0 |
|
|
absent diastolic blood flow |
1 |
|
|
reverse diastolic blood flow |
2 |
|
umbilical vein of recipient |
no pulsations |
0 |
|
|
pulsations |
1 |
|
right-sided outflow tract in recipient |
pulmonary artery > aorta |
0 |
|
|
pulmonary artery = aorta |
1 |
|
|
pulmonary artery < aorta |
2 |
|
|
RV outflow obstruction |
3 |
|
PVR in recipient |
none |
0 |
|
|
present |
1 |
total score =
= SUM(points for all 12 parameters)
Interpretation:
• minimum score: 0
• maximum score: 20
|
Total Score |
Cardiovascular Grade |
|
0 to 5 |
1 |
|
6 to 10 |
2 |
|
11 to 15 |
3 |
|
16 to 20 |
4 |
Specialty: Pedatrics
