Hepatic arterial buffer response: activation in donor fetuses and the effect of laser ablation of intertwin anastomosis.
J Perinat Med
; 52(1): 71-75, 2024 Jan 29.
Article
em En
| MEDLINE
| ID: mdl-37850825
ABSTRACT
OBJECTIVES:
Hepatic arterial buffer response (HABR) is an important defence mechanism for maintaining liver blood flow. It is suspected that HABR is active in monochorionic diamniotic twins (MCDA) with twin-to-twin transfusion syndrome (TTTS) where donor compensates a setting of volume depletion and the recipient an overload. The present study investigates whether in TTTS, HABR is active in donor and/or recipient individually and try to determine if the activation of HABR is a direct response to TTTS.METHODS:
Hepatic artery (HA) peak systolic velocity (PSV) was measured in normal MCDA fetuses and TTTS. Correlation with relevant fetal Dopplers and characteristics were determined. Z-scores for HA-PSV (HAV-Z) were calculated and its association with TTTS in donors and recipients were determined as well as changes in HAV-Z after laser treatment.RESULTS:
In this study 118 MCDA were included, 61.9â¯% normal and 38.1â¯% TTTS. Of the TTTS 22 required laser treatment. A total of 382 scans were performed in normal group and 155 in TTTS. Our data demonstrates that in donors HAV-Z was 2.4 Z-scores higher compared to normal fetuses (ß=2.429 95â¯% CI 1.887, 2.971; p<0.001) and after laser treatment HAV-Z reduced (ß=-1.829 95â¯% CI -2.593, -1.064; p<0.001). There was no significant difference between recipients and normal (ß=-0.092 95â¯% CI -0.633, 0.449; p=0.738).CONCLUSIONS:
HABR is active in TTTS, promoting an increased hepatic blood flow in donors. The activation is direct response to TTTS as shown by the reduction in HAV-Z after laser. This finding provides important insights into the pathophysiology of TTTS.Palavras-chave
Texto completo:
1
Coleções:
01-internacional
Base de dados:
MEDLINE
Assunto principal:
Terapia a Laser
/
Transfusão Feto-Fetal
Limite:
Female
/
Humans
/
Pregnancy
Idioma:
En
Revista:
J Perinat Med
Ano de publicação:
2024
Tipo de documento:
Article
País de afiliação:
Portugal