Selective reduction by intracardiac potassium chloride injection following successful laser therapy for twin-twin transfusion syndrome: Report of two cases

BACKGROUND: Intracardiac injection of potassium chloride (KCl) for selective reduction cannot be applied in cases of monochorionic twin pregnancy due to intertwin anastomoses. In twin-twin transfusion syndrome (TTTS) following successful laser therapy, the intertwin anastomoses are theoretically coagulated, and KCl intracardiac injections for selective reductions can be applied. CASES: In Case 1 a woman with stage II TTTS received laser therapy and the donor twin was found through ventriculomegaly 10 days after the operation. Intracar-diac KCl injection for selective reduction was applied at gestational age 23 weeks +4 days. The pregnancy ended at 34 weeks +2 days, at which time a cesarean delivery method was adopted due to the mother’s history of cesarean section. In Case 2 a woman with stage III TTTS received laser therapy at gestational age 23 weeks +4 days; 3 weeks later the donor twin developed ventriculomegaly. Selective reduction through intra-cardiac KCl injection was performed at gestational age 31 weeks +6 days. The normal cotwin was delivered at 37 weeks by cesarean section due to malpresentation. CONCLUSION: Intracardi-ac KCl injection for selective reduction in TTTS following successful laser therapy can be applied after thorough consultation. (J Reprod Med 2021;66:232–236).