Selective Laser Photocoagulation of Communicating Vessels in Twin-Twin Transfusion Syndrome
Condition: Twin Twin Transfusion Syndrome
MeSH terms: Fetofetal Transfusion; Syndrome
Study type: Observational

Summary: 
      Patients undergo a detailed ultrasound examination to rule out the presence of congenital
      anomalies, and to assess the hemodynamic status of the fetuses. Patients with confirmed TTTS
      will be considered candidates for the trial. Patients will be counseled about the risks and
      benefits of all treatment options and will be free to choose any treatment option. They will
      then be asked to sign an informed consent. The procedure will be performed under local
      anesthesia. After a 2-3 mm skin incision, and under ultrasound guidance, the trocar will be
      introduced in the amniotic cavity of the Recipient twin. The communicating vessels will be
      located endoscopically and will be lasered with YAG laser energy. An accessory port may be
      required in some cases. The procedure will be monitored both endoscopically and
      sonographically. The presence of fetal heart activity will be noted often during the
      procedure. An amniodrainage of the larger sac may be performed at the time of the procedure.
      The patient will remain hospitalized 1-3 days and will undergo an ultrasound assessment on
      the first post operative day. Patients will undergo a weekly ultrasound examination for four
      weeks after the initial therapeutic procedure. Sonographic parameters to evaluate will
      include: maximum vertical pocket of fluid in each sac, visualization of the fetal bladders,
      absence or presence of hydrops, and Doppler studies of the umbilical artery, umbilical vein,
      ductus venosus, and middle cerebral artery. After delivery babies will be assessed by their
      corresponding neonatologists or pediatricians. Infants admitted to the neonatal intensive
      care unit will be followed through their discharge. Evidence of neurological or cardiac
      morbidity will be sought in each twin. If either of these complications is suspected,
      evaluation by pediatric neurology or pediatric cardiology will be requested. Babies will be
      followed up for neonatal, infant and childhood morbidity or mortality. It is requested that
      all placentas be delivered fresh to Tampa General Hospital in an icebox container for
      assessment. Placentas will be discarded after analysis.
    


Intervention name(s): Selective Laser Photocoagulation of Communicating Vessels
Intervention type(s): Device
Intervention description(s): Patients will be admitted to Tampa General Hospital. Laboratory tests and anesthesia assessments will be completed. Antibiotic prophylaxis is initiated within an hour of surgery and continued every 8 hours through the first post-operative day. Surgery will be performed preferably under local anesthesia for the mother using 1% xylocaine with epinephrine at the trocar entry site, and IV sedation. Surgery will be performed with standard operative fetoscopy equipment and techniques. A trocar will be introduced in the amniotic cavity of the recipient. An amniotic fluid sample will be obtained for microbiological studies, and genetic analysis for clinical care only. The amniotic fluid will be discarded after analysis. The communicating vessels will be located endoscopically and will be lasered with YAG laser energy. The procedure will be monitored both endoscopically and sonographically. The presence of fetal heart activity will be noted. An amniodrainage of the larger sac may be performed
Other intervention name(s): SLPCV