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>> TWIN-TWIN TRANSFUSION SYNDROME IS NOT SIMPLY
A PHENOMENON OF A DIFFERENCE IN SIZE.
IT HAS A CARDIOVASCULAR ORIGIN TO IT.
>> THERE ARE CERTAIN CHARACTERISTICS,
WHICH WE'VE COME TO APPRECIATE,
THAT ARE THE RESULT OF EACH FETUS'S ADAPTATION
OR ADAPTIVE RESPONSE TO THE CHANGES THAT OCCUR SECONDARY
TO TWIN-TWIN TRANSFUSION SYNDROME.
AS A RESULT, WE'VE BEEN ABLE TO DEVELOP A CHOP
CARDIOVASCULAR SCORING SYSTEM.
>> BETWEEN FETAL CARDIOLOGISTS AND MATERNAL-FETAL MEDICINE
AND PERINATOLOGY EXPERTS, IT WAS THE COMBINING
OF THEIR EXPERIENCES IN OBSERVING THIS
TWIN-TWIN TRANSFUSION PHENOMENON THAT REALLY
HAS RESULTED IN THE DEVELOPMENT OF THIS VERY,
VERY UNIQUE SCORING SYSTEM.
>> THE ENTIRE PREGNANCY HAS TO BE MONITORED
EXTREMELY CLOSELY.
IT HAS TO BE MONITORED FOR SIGNS THAT THE BABIES
ARE DEVELOPING HEART FAILURE.
>> THE FETAL HEART IS SORT OF THE MOTOR THAT MAKES
THE FETUS RUN AND THE PLACENTA RUN.
AND THAT'S USUALLY THE END STAGE PATHOPHYSIOLOGIC EVENT
THAT LEADS TO EITHER DEATH OR NEUROLOGIC COMPLICATIONS.
SO IT'S IMPORTANT THAT WE FOLLOW THE FETAL HEART CLOSELY.
>> THERE ARE FIVE DOMAINS THAT EXIST WITHIN
THE TWIN-TWIN TRANSFUSION SCORE.
THE FIRST FOUR DOMAINS RELATE TO CHARACTERISTICS
OF THE RECIPIENT AND THE FIFTH RELATES TO CHARACTERISTICS
IN THE DONOR.
>> BY LOOKING SPECIFICALLY AT THE HEART OF BOTH TWINS,
THEY ARE ABLE TO TELL SUBTLE CHANGES, WHEN A HEART MIGHT
BE GOING INTO CARDIAC FAILURE,
WHEN TO INTERVENE WITH A LASER BEFORE GOING INTO
CARDIAC FAILURE, AND IN SOME INSTANCES SOME PREDICTION
OF HEART DISEASE.
>> NOT ONLY IS THE SCORE HELPFUL IN OUR DECISION TREE
IN UNDERSTANDING WHO CAN BENEFIT FROM INTERVENTION,
IT ALSO IS A MEANS POTENTIALLY FOR PROGNOSIS.
>> WE HAVE ACTUALLY UTILIZED THE SAME SYSTEM TO GAUGE
THE RESPONSE POSTOPERATIVELY.
AND WHAT WE'VE COME TO APPRECIATE AND WHAT
IS EXTRAORDINARILY REMARKABLE IS THAT THE CARDIAC CHANGES
THAT WE SEE PREOPERATIVELY AS A RESULT OF TWIN-TWIN
TRANSFUSION SYNDROME CAN BE REVERSED OR RESOLVED
POSTOPERATIVELY WHEN WE APPLY THE SAME SCORING SYSTEM.
>> IT'S STILL UNCLEAR EXACTLY HOW MANY PATIENTS
ARE GOING TO HAVE RESIDUAL, LONG-STANDING, PERMANENT
CHANGES.
BUT WHAT WE DO KNOW THROUGH THE USE OF THE SCORE IS THAT
THE VAST MAJORITY IN FACT HAVE FAIRLY GOOD RESOLUTION
OF THE CARDIOVASCULAR FINDINGS.
>> SO IT REALLY TAKES VERY EXPERIENCED AND FOCUSED
TALENTS JUST LOOKING AT FETAL ECHOCARDIOGRAMS.