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• W2188552778 abstract "Introduction: The twin-to-twin transfusion syndrome (TTTS) is a severe complication of monochorionic (MA) twin pregnancies, caused by a net inter-twin transfusion of blood from one fetus (the donor) towards the other fetus (the recipient) through placental anastomoses. TTTS is most often driven by unidirectional arterio-venous anastomoses, and mitigated by bidirectional arterio-arterial or veno-venous anastomoses. In contrast to this concept some cases describe AA anastomoses as a cause of the TTTS. Case presentation: We describe the case of the monochorionic twin pregnancy complicated by the TTTS. In the course of this pregnancy the typical for TTTS symptoms occurred: fetal growth discordance, impaired Doppler blood flow in the compromised fetus. With the pregnancy developing the symptoms deteriorated, finally forcing us to finish the pregnancy by caesarean section. TTTS was most probably caused by the single bi-directional arterio-arterial anastomosis discovered in US scan. Discussion: Unidirectional arterio-venous (AV) anastomoses often result in twin-twin transfusion syndrome (TTTS). However, oppositely directed anastomoses may compensate for the circulatory imbalance and either prevent, delay the onset, or moderate the severity of TTTS. Intuitively, higher pressure gradient, oppositely-directed AV anastomoses (indicated as VA) would be expected to compensate better for TTTS than lower pressure gradient arterio-arterial (AA) anastomoses. In other study the angioarchitecture of 395 monochorionic twin placentas was studied. Mortality was highest in the absence of an arterio-arterial anastomosis (42%) and lowest in the presence of an arterio-arterial anastomosis (15%). But if mortality occurred, pregnancies with double mortality usually had an arterio-arterial anastomosis. If pregnancies were complicated by one death, a veno-venous anastomosis was more likely to be present. The above mentioned arguments provide evidence that the arterio-arterial anastomosis represents a functional collateral artery which outgrowth is driven by an increased shear-stress caused by an increased flow to a lower pressure vascular bed in the placenta of the recipient. The lower arterial pressure occurs from the moment that a chorionic artery which is connected to the anastomosis develops a significant stenosis. The resulting collateral flow through the anastomosis maintains blood supply to the lower pressure placental bed, the beneficial function of collaterals, but also results in an increasing net inter-twin transfusion which triggers the onset of severe TTTS [3]. The same phenomena was observed in our study." @default.
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• W2188552778 date "2008-01-01" @default.
• W2188552778 modified "2023-09-24" @default.
• W2188552778 title "The twin pregnancy complicated by the twin-to-twin transfusion syndrome, caused by the existence of the bilateral arterio-arterial anastomosis" @default.
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