双胎間輸血症候群の心筋病理 : 受血児における心筋肥厚の臨床病理学的意義

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  • ソウタイカン ユケツ ショウコウグン ノ シンキン ビョウリ ジュケツジ ニ オケル シンキン ヒコウ ノ リンショウ ビョウリガクテキ イギ
  • Myocardial Pathology of Twin-to-twin Transfusion Syndrome : Clinicopathological Significance of Myocardial Hypertrophy in Recipient Twins

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説明

Twin-to-twin transfusion syndrome (TTTS) is associated with monochorionic diamniotic twins and signifi-cantly affects perinatal prognosis. Although its pathophysiology remains unclear, it is generally thought to result from the transfusion of blood from the donor twin to the recipient twin via vascular anastomoses within the placenta. In particular, recipient twins often develop cardiovascular abnormalities attributed to excessive volume loading of the heart in the womb, such as cardiomegaly, myocardial hypertrophy, and atrioventricular valvular regurgitation. The present study is a pathological study on the causes and clinical significance of myocardial hypertrophy in recipient twins based on findings on myocardial pathology obtained from seven autopsy cases of severe TTTS. Histological examination revealed that the ventricles of recipient twins had a larger diameter of myocardial cells in addition to a smaller number of cells per unit area compared to controls, suggesting hypertrophy of myocardial cells. Therefore, cardiomegaly was thought to be primarily caused by myocardial cell hypertrophy. Although myocardial cell hypertrophy occurs with endocardial fibroelastosis, interstitial edema and disarray were not considered specific findings. These findings support the results of a follow-up using echocar-diography, which showed that myocardial hypertrophy in recipient twins reflects a state of excess afterload or hypertension in the womb, and that in cases of survival, regression from this state after birth leads to improvements in myocardial hypertrophy after several months.

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