Ultrasound assessment and surgical treatment of twin-twin transfusion syndrome

Abstract

The ultrasound diagnosis, management and treatment of twin-twin transfusion syndrome (TTTS) have had a remarkable number of positive developments in the last 20 years. Together, they have resulted in TTTS being the most common condition seen and treated in fetal therapy centers today. This chapter discusses the basic ultrasound assessment of TTTS patients in a step-by-step fashion, to provide a structure to the sonographic examination. This includes review of the diagnostic criteria, the sonographic assessment of disease severity and preoperative ultrasound assessment. The chapter also reviews the rationale for, as well as the fundamental laser technique and its variations, including the nonselective technique, selective laser photocoagulation of communicating vessels (SLPCV), sequential selective laser photocoagulation of the communicating vessels (SQLPCV) and the 'Solomon' technique, and provides potential explanations for the outcome differences of each technique. Future developments in terms of surgical technique and long-term outcome studies are also discussed.