Narrated fetal laser surgery broadcast answers viewers' questions

August 19, 2008 -- Tampa General Hospital (Tampa, FL) says it will broadcast highlights of a fetal laser surgery for twin-to-twin transfusion syndrome (TTTS) from on the Internet. Rubén Quintero, M.D., Medical Director of Maternal Fetal Medicine/Fetal Surgery will narrate and answer e-mail questions live as taped highlights of the procedure are shown. Quintero is developer of an endoscopic technique that pinpoints malfunctioning placental blood vessels and uses a laser to seal them.

August 19, 2008 -- Tampa General Hospital (Tampa, FL) says it will broadcast highlights of a fetal laser surgery for twin-to-twin transfusion syndrome (TTTS) from on the Internet.

The broadcast depicts a pair of identical-twin fetuses afflicted by TTTS, which affects 10 to 15 percent of such pregnancies and is the result of abnormal blood exchange through a common placenta. The larger of the twins, or recipient, is surrounded by too much amniotic fluid and in danger of heart failure as its body tries to pump the overwhelming volume of blood intended for both. The smaller, or donor twin, is encased in a shrinking amniotic sac deprived of blood. Without treatment, both were likely to die.

Rubén Quintero, M.D., Medical Director of Maternal Fetal Medicine/Fetal Surgery at Tampa General Hospital and Professor and Director of the Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of South Florida College of Medicine will narrate the procedure and answer e-mail questions live as taped highlights of the procedure are shown.

The broadcast, originally scheduled for Wednesday, August 20, 2008 at 4 p.m. EDT, has been postponed due to hurricane threats in Florida; at the website you can sign up to receive a reschedule alert.

Ultrasound is used to diagnose TTTS by noting the presence of combined polyhydramnios (excess amniotic fluid) and oligohydramnios (decreased amniotic fluid) in a monochorionic-diamniotic (one placenta; two amniotic sacs) twin pregnancy. Polyhydramnios is defined as a maximum vertical pocket (MVP) of 8 cm or more, and oligohydramnios as an MVP of 2cm or less.

The surgical treatment of TTTS took a turn in 1998 when Quintero developed a selective endoscopic technique that pinpoints which placental blood vessels are malfunctioning and uses a laser to seal off those specific vessels. The goal of this approach is to eliminate all blood exchange between the fetuses. This one-time laser surgery procedure halts the disease process and allows each fetus to continue the pregnancy from its individually-perfused placenta. The procedure takes approximately 30 to 45 minutes to complete. Before this procedure was available, amniocentesis was performed several times during the pregnancy to improve blood flow in the placenta by removing excess fluid.

The TGH Fetal Therapy/Surgery Program was established in 2006 and provides management of life-threatening fetal complications before birth utilizing the most advanced forms of prenatal diagnosis and in-utero treatment. Over 800 laser surgery procedures for twin-to-twin transfusion syndrome have been performed with 75% survival for both and 90% survival for at least one fetus.

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