TREATMENT OF TWIN-TWIN TRANSFUSION SYNDROME BY LASER AND DIGOXIN - BIOPHYSICAL AND ANGIOGRAPHIC EVALUATION

Objectives: A combination of surgical and medical approaches may addre ss both the underlying pathophysiological processes and the most threa tening symptoms in twin-twin transfusion syndrome (TTTS). Case: A prim igravida with monochorionic twin pregnancy was referred with signs of TTTS at 16 weeks. One twin was severely hydropic with normal amniotic fluid, the cotwin had anhydramnios. Laser treatment was performed. Nev ertheless, signs of severe cardiac decompensation in the recipient rem ained unchanged. After treatment with digoxin restoration of congestiv e heart failure and a resolution of the hydrops were achieved. Activit y and inter-twin contacts increased significantly. At 37 weeks 2 healt hy boys were delivered. Postnatal computerangiography of the placenta revealed no arteriovenous anastomoses. Conclusions: This case suggests that a combined causal and symptomatic therapy in cases with cardiac decompensation of the recipient can be beneficial as demonstrated by e chocardiography, venous Doppler and behavioral analysis. Computer angi ography of the placenta may demonstrate the effect of laser treatment.