Title: Simulated sequential laser therapy of twin-twin transfusion syndrome
Authors: van Gemert, M J C ×
van den Wijngaard, J P H M
Lopriore, E
Lewi, Liesbeth
Deprest, Jan
Vandenbussche, F P H A #
Issue Date: Jul-2008
Series Title: Placenta vol:29 issue:7 pages:609-13
Abstract: Sequential laser therapy of twin-twin transfusion syndrome (TTTS) includes laser obliteration of arteriovenous (AV) anastomoses from donor to recipient (AVDR) before obliterating AV anastomoses from recipient to donor (AVRD). This strategy allows for a beneficial intra-operative transfusion of blood from the hypervolemic recipient to the hypovolemic donor. In the present study, we sought to analyze the benefits and risks of sequential laser therapy with our computational model to aid its more widespread introduction. We simulated an equally shared placenta with an AVDR and a smaller diameter AVRD causing TTTS at 20weeks. Laser coagulation and various volumes and directions of inter-twin transfusion were simulated at 21weeks. A typical result is that when an AVDR is coagulated first, and 10min later the AVRD with inner diameter of about 1mm, an inter-twin transfusion of 25ml may result from the recipient to the donor, based on literature data of AV flow versus diameter. This procedure causes a simulated loss of 50% of the recipient's blood volume. The opposite coagulation sequence, thus coagulating the AVRD first, 10min later followed by the AVDR of 1mm inner diameter, causes a loss of the donor's blood volume of 64%. In conclusion, our simulations support the concept of sequential laser therapy for TTTS and suggest directions for an improved safety and efficacy of this strategy.
ISSN: 0143-4004
Publication status: published
KU Leuven publication type: IT
Appears in Collections:Foetal Medicine Section (-)
Section Woman - Miscellaneous (-)
× corresponding author
# (joint) last author

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