Simplified point-of-care ultrasound protocol to confirm central venous catheter placement: A prospective study.

Background: The current standard for confirmation of correct supra-diaphragmatic central venous catheter (CVC) placement is with plain film chest radiography (CXR). We hypothesized that a simple point-of-care ultrasound (POCUS) protocol could effectively confirm placement and reduce time to confirmation.

Methods: We prospectively enrolled a convenience sample of patients in the emergency department and intensive care unit who required CVC placement.

Thrombosis of Inferior Vena Cava Diagnosed Using Point-of-Care Ultrasound After Pediatric Near-Syncope.

Background: Venous thromboembolism (VTE) is extremely rare but under recognized in the pediatric population. Although the literature on the use of ultrasound to detect VTEs in adults is plentiful, little has been documented on its use in the pediatric population.

Case Report: We present a case of a healthy 16-year-old female who presented to our emergency department with 3 months of dyspnea on exertion and one episode of near-syncope.

Normalization of amniotic fluid levels after fetoscopic laser surgery for twin-twin transfusion syndrome.

Objective: The purpose of this study was to describe amniotic fluid (AF) normalization after laser surgery for twin-twin transfusion syndrome (TTTS).

Methods: Patients with TTTS (n = 174) who had laser surgery from 2006 through 2009 underwent serial measurements of the AF maximum vertical pockets (MVPs) during postoperative weeks 1 through 10. A normal MVP was defined as greater than 2 cm and less than 8 cm.

Postoperative middle cerebral artery peak systolic velocity changes confirm physiological principles of the sequential laser technique for twin-twin transfusion syndrome.

Introduction: Treatment of the twin-twin transfusion syndrome (TTTS) via sequential selective laser photocoagulation of communicating vessels (SQLPCV) mandates ablation of donor-to-recipient arteriovenous anastomoses first. It is hypothesized that SQLPCV facilitates intraoperative transfusion to the donor, thereby minimizing donor hypovolemia and anemia. We sought to determine if postoperative changes in fetal middle cerebral artery-peak systolic velocities (MCA-PSV) support this hypothesis.

Discordant blood chimerism in dizygotic monochorionic laser-treated twin-twin transfusion syndrome.

Background: Twin-twin transfusion syndrome occurs in 10% of monozygotic monochorionic twin gestations and results from an unbalanced exchange of blood from the donor to the recipient fetus through placental anastomoses.

Case: We present a case of twin-twin transfusion syndrome with differing fetal sex treated with in utero laser surgery. Genetic analyses showed 46,XX/46,XY hematologic chimerism in both twins at birth and at 6 months, with the recipient twin being significantly more chimeric than the donor.

Spontaneous twin anemia-polycythemia sequence complicated by recipient placental vascular thrombosis and hydrops fetalis.

Twin anemia-polycythemia sequence (TAPS) is an atypical form of twin-twin transfusion syndrome (TTTS) that presents as a large intertwin hemoglobin difference with one twin developing anemia and the other developing polycythemia, without oligohydramnios-polyhydramnios sequence (Lopriore et al., Placenta 2007;28:47-51). The prenatal diagnostic criteria for TAPS require that the middle cerebral artery-peak systolic velocity (MCA-PSV) measure greater than 1.

Amniopatch as a treatment for rupture of membranes following laser surgery for twin-twin transfusion syndrome.

Objective: The risk of iatrogenic rupture of membranes (IROM) is 5-30% after operative fetoscopy. The aim of this study was to describe outcomes of patients with IROM following selective laser photocoagulation of communicating vessels (SLPCV) for twin-twin transfusion syndrome (TTTS) who were subsequently treated with amniopatch therapy.

Methods: A review of patients who underwent treatment for mid-trimester TTTS between March 2006 and February 2008 with IROM within 7 days of SLPCV was performed.