Cutting-edge foetal laser surgery calls halt to twin-to-twin transfusion syndrome

Tampa 21 January 2000Nothing can prepare parents expecting twins for the news that the placenta shared by the foetuses is not allowing blood to flow equally between them, putting both at risk. Yet this is the grim reality for the 10 to15 percent of identical twin pregnancies affected by twin-to-twin transfusion syndrome, a relatively unknown condition. Just recently, The Health Network, one of the leading television and Internet health destinations, has aired on its web site a pioneering laser surgery to correct the condition.


The surgery has been performed by the internationally acclaimed surgeon Ruben Quintero, M.D., at St. Joseph's Women's Hospital in Florida, on Dionne Alexander, a 27-year-old computer drafter from Louisiana. The patient was 20 weeks pregnant with identical twins. Walt Larimore, M.D., of The Health Network hosted the surgery. One of Dr. Quintero's partners, who is Craig Kalter, M.D., of Florida Perinatal Associates answered all the call-in questions from viewers.

Mrs. Alexander decided to make her surgery public via web cast in order to make parents more aware of the twin-to-twin transfusion syndrome. Many people do not know this condition even exists, much less that it endangers up to 3000 sets of twins each year. Mrs. Alexander wanted other parents to realise they are not alone, and to know that there are new and valid options for treating it.

The twin-to-twin transfusion syndrome, also known as TTTS, is a condition in which an unbalanced sharing of blood occurs between the two foetuses through connecting blood vessels which are present in a common placenta. In the extreme situation, one foetus is larger and swollen with an excessive amount of amniotic fluid, which is the recipient twin, while the other foetus is smaller and stuck against the uterine wall with very little or no amniotic fluid, which is the so-called donor twin. The cause of death may be from cardiac overload in the recipient twin, loss of blood in the donor twin, or pre-term labour from the excess fluid resulting in premature delivery. Severe TTTS has a mortality rate of more than 90 percent if not treated.

Dr. Ruben Quintero revolutionised the surgical treatment of TTTS when he developed the novel selective technique for lasering specific malfunctioning vessels. This technique identifies the vessels which are participating in the syndrome and then with laser energy coagulates those vessels and stops the blood flow. Dr. Quintero has made a one-tenth inch incision in the patient's abdomen and inserted an endoscope which enabled him to see and identify these vessels. The following day, an ultrasound was performed to evaluate the status of the foetuses. Within a few days, the fluid levels have returned to normal. After the ultrasound, the patient is usually discharged. Although monitoring is still required, further intervention should not be necessary.

When asked, Dr. Quintero stated that in his travels throughout the world, he had discovered that several people, physicians included, do not know of the advances which have been made in foetal surgery. His hope is that the live web cast has shown people the safety and benefits of foetal surgery and also others like it. Currently, Dr. Quintero is one of only a few doctors performing this procedure throughout the world. He has performed more than 100 laser surgeries with an 84 percent survival rate for at least one baby and 40 to 50 percent for both.

St. Joseph's Women's Hospital, for more than 25 years, has offered women in the Tampa Bay area one place to turn to for their medical needs. As the largest provider of health care services exclusively for women in Florida, this 234-bed speciality hospital offers complete obstetrical, peri-natal, surgical, gynaecological and educational services. Programmes focus on prevention for women's bodies, spirits and their peace of mind.

Leslie Versweyveld

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