Lasers Med Sci 2000, 15:76–81 © 2000 Springer-Verlag London Limited
Abstracts Laser Therapy of Monochorionic Twin–Twin Transfusion Syndrome Pregnancies
Twin-Twin Transfusion Syndrome: One Investigator’s 15 Year Legacy J.E. De Lia, Department of Obstetrics & Gynecology, University of Illinois at Chicago, Chicago, Illinois, USA
The ability to diagnose previable twin-to-twin transfusion syndrome (TTTS) in utero by ultrasound occurred in the early 1980s. Despite various attempts at therapy (reduction amniocentesis, feticide), TTTS remained characterised by high perinatal mortality and morbidity rates. Since the pathophysiology is ultimately traced to anastomotic vessels between the monochorionic (MC) twins, in 1983 we proposed surgical ablation of these connections via fetoscopically-delivered Nd:YAG laser. After preliminary tests in the ovine and primate models, and fabrication of an operative laser fetoscope, the first human fetoscopic laser occlusion of chorioangiopagous vessels (FLOC) for previable TTTS was performed in 1988. After a seven year learning curve outcomes of FLOC are 82% at least one survivor and 69% overall surviving twins (versus 5% untreated) at 21.1 weeks’ mean gestational age of treatment, treatment to delivery interval of mean 9.9 weeks, and
Abstracts Laser Therapy of Monochorionic Twin–Twin Transfusion Syndrome Pregnancies
Twin-Twin Transfusion Syndrome: One Investigator’s 15 Year Legacy J.E. De Lia, Department of Obstetrics & Gynecology, University of Illinois at Chicago, Chicago, Illinois, USA
The ability to diagnose previable twin-to-twin transfusion syndrome (TTTS) in utero by ultrasound occurred in the early 1980s. Despite various attempts at therapy (reduction amniocentesis, feticide), TTTS remained characterised by high perinatal mortality and morbidity rates. Since the pathophysiology is ultimately traced to anastomotic vessels between the monochorionic (MC) twins, in 1983 we proposed surgical ablation of these connections via fetoscopically-delivered Nd:YAG laser. After preliminary tests in the ovine and primate models, and fabrication of an operative laser fetoscope, the first human fetoscopic laser occlusion of chorioangiopagous vessels (FLOC) for previable TTTS was performed in 1988. After a seven year learning curve outcomes of FLOC are 82% at least one survivor and 69% overall surviving twins (versus 5% untreated) at 21.1 weeks’ mean gestational age of treatment, treatment to delivery interval of mean 9.9 weeks, and
