Twin-twin transfusion syndrome: The 'select' procedure

Vickie A. Feldstein, Geoffrey A. Machin, Craig T. Albanese, Per Sandberg, Jody A. Farrell, Diana L Farmer, Michael R. Harrison

Research output: Contribution to journalArticlepeer-review

41 Scopus citations


Objectives: Twin-twin transfusion syndrome (TTTS) is associated with a high risk of perinatal morbidity and mortality. The condition results from intertwin vascular connections in the shared placenta. We report here a case of early, severe TTTS that failed to respond to serial amniocenteses and that was successfully treated by means of superselective laser coagulation. Methods: A causative arteriovenous anastomosis was identified by means of prenatal obstetrical sonography, using color and spectral Doppler techniques. At fetoscopy, performed at 23 weeks' gestation, laser occlusion of only this connection was achieved. Results: This therapeutic intervention resulted in rapid resolution of all evidence of TTTS and a successful pregnancy outcome, with subsequent delivery of 2 healthy infants at 33 weeks' gestation. Conclusions: The potentially fatal pathophysiology of TTTS was reversed by interruption of a single arteriovenous connection. We have termed this the sonographically evaluated, laser-endoscopic coagulation for twins ('Select') procedure. Copyright (C) 2000 S. Karger AG, Basel.

Original languageEnglish (US)
Pages (from-to)257-261
Number of pages5
JournalFetal Diagnosis and Therapy
Issue number5
StatePublished - Sep 2000


  • Doppler sonography
  • Fetoscopy
  • Laser coagulation
  • Monochorionic twins
  • Nd:YAG laser
  • Placental vessel
  • Twin-twin transfusion syndrome

ASJC Scopus subject areas

  • Obstetrics and Gynecology
  • Pediatrics, Perinatology, and Child Health


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