TTTS. Medical Treatment
Medical treatment of TTTS has included only isolated case reports involving the use of digoxin3–5 or indomethacin.6–8 The rationale for the use of digoxin is to treat a recipient twin in heart failure.
Relatively high maternal serum levels of digoxin must be achieved in order to reach therapeutic levels in TTTS, as the mean feto–maternal gradient is 0.56.9 Fetal levels are also directly related to GA.
Of the three articles describing the use of digoxin, only one patient was treated successfully with this medication alone. Of the three articles describing the use of indomethacin, no obvious benefit from the use of this medication was found.
These findings are not surprising, considering the opposite hemodynamic status of the recipient and the donor twin. Based on the limited evidence available, medical treatment of TTTS, at least as a first-line therapy, is currently not recommended. Level of evidence: III.
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