Twin-twin transfusion syndrome: The 'Select' procedure

Objectives: Twin-twin transfusion syndrome (TTTS) is associated with a high risk of perinatal morbidity and mortality. The condition results from inte rtwin vascular connections in the shared placenta. We report here a case of early, severe TTTS that failed to respond to serial amniocenteses and that was successfully treated by means of superselective laser coagulation. Met hods: A causative arteriovenous anastomosis was identified by means of pren atal obstetrical sonography, using color and spectral Doppler techniques. A t fetoscopy, performed at 23 weeks' gestation, laser occlusion of only this connection was achieved, Results: This therapeutic intervention resulted i n rapid resolution of all evidence of TTTS and a successful pregnancy outco me, with subsequent delivery of 2 healthy infants at 33 weeks' gestation. C onclusions: The potentially fatal pathophysiology of TTTS was reversed by i nterruption of a single arteriovenous connection, We have termed this the s onographically evaluated, laser-endoscopic coagulation for twins ('Select') procedure. Copyright (C) 2000 S. Karger AG, Basel.