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Twin-Twin Transfusion Syndrome Complicated by Proximate Placental Cord Insertion Sites: Endoscopic Clip-Assisted Laser Occlusion

Authors
  • Chon, Andrew H.
  • Pham, Huyen Q.
  • Chmait, Ramen H.
Type
Published Article
Journal
Fetal Diagnosis and Therapy
Publisher
S. Karger AG
Publication Date
Aug 06, 2020
Volume
47
Issue
10
Pages
779–784
Identifiers
DOI: 10.1159/000509235
PMID: 32759605
Source
Karger
Keywords
License
Green
External links

Abstract

Introduction: Severe twin-twin transfusion syndrome (TTTS) with a large vascular communication between proximate placental cord insertion sites is a therapeutic dilemma because laser ablation may cause thermal injury to the cord roots and subsequent fetal demise. Case Presentation: Stage IV TTTS with placental cord insertion sites 1.3 cm apart and with an intervening large arterio-arterial (AA) anastomosis presented for treatment. The application of endoclips onto the large AA anastomosis between the cord roots allowed for successful laser occlusion using minimal energy. Both the donor and recipient twins were alive and well at 6 months of age. Conclusion: Endoscopic clip-assisted laser occlusion of a placental vessel is technically feasible and may be a useful therapeutic option in select cases.

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