2,834 results match your criteria Twin-to-Twin Transfusion Syndrome


Effect of gestational age at laser therapy on perinatal outcome in monochorionic diamniotic pregnancies affected by twin-to-twin transfusion syndrome.

BJOG 2022 May 21. Epub 2022 May 21.

Hôpital universitaire Necker-Enfants malades, Obstetrics and fetal medicine, Paris, France.

Objective: To evaluate the effect of gestational age at laser therapy for twin-to-twin transfusion syndrome (TTTS) on perinatal outcome.

Design And Settings: Single retrospective observational cohort.

Population: All consecutive pregnancies affected by TTTS and referred to our department between January 2013 and August 2020. Read More

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Twin-to-twin transfusion syndrome: Controversies in the diagnosis and management.

Best Pract Res Clin Obstet Gynaecol 2022 Mar 30. Epub 2022 Mar 30.

University Medical Center Hamburg-Eppendorf, Department of Obstetrics and Fetal Medicine, Hamburg, Germany.

In twin-to-twin transfusion syndrome (TTTS) communicating placental vessels on the chorionic plate between the donor and recipient twins are responsible for the chronic imbalance of blood flow. Evidence demonstrates that fetoscopic laser ablation is superior to serial amnioreductions in terms of survival and neurological outcome for stages II-IV TTTS. However, the optimal management of stage I TTTS remains poorly understood. Read More

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Impact of Preoperative Cervical Length on Pregnancy Outcome in Twin-Twin Transfusion Syndrome.

Z Geburtshilfe Neonatol 2022 May 11. Epub 2022 May 11.

University of Barcelona, Institut d'Investigations Biomèdiques August Pi i Sunyer (IDIBAPS), and Centre for Biomedical Research on Rare Diseases (CIBER-ER), BCNatal | Fetal Medicine Research Center (Hospital Clínic and Hospital Sant Joan de Déu), Barcelona, Spain.

Objective: To evaluate the impact of preoperative cervical length on pregnancy outcome in monochorionic diamniotic twin pregnancies complicated by twin-twin transfusion syndrome that underwent laser surgery or cord occlusion.

Materials And Methods: Retrospective study of 330 patients stratified by preoperative cervical length (≥25 mm, 16-24 mm,≤15 mm). Maternal characteristics, operative data, and pregnancy outcomes were compared between the cervical length groups as well as between the subgroups of patients with a cervical length≤15 mm according to management (expectant vs. Read More

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The role of Australian clinical quality registries in pregnancy care: A scoping review.

Aust N Z J Obstet Gynaecol 2022 May 11. Epub 2022 May 11.

Department of Obstetrics and Gynaecology, The University of Melbourne, Parkville, Victoria, Australia.

Background: Pregnancy represents a time of increased morbidity and mortality for women and their infants. Clinical quality registries (CQRs) collect, analyse and report key healthcare quality indicators for patient cohorts to improve patient care. There are limited data regarding existing CQRs in pregnancy. Read More

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Comprehensive Metabolomic Profiling of Cord Blood and Placental Tissue in Surviving Monochorionic Twins Complicated by Twin-Twin Transfusion Syndrome With or Without Fetoscopic Laser Coagulation Surgery: A Retrospective Cohort Study.

Front Bioeng Biotechnol 2022 12;10:786755. Epub 2022 Apr 12.

Institute of Metabolism and System Research, University of Birmingham, Birmingham, United Kingdom.

To investigate metabolomic perturbations caused by twin-twin transfusion syndrome, metabolic changes associated with fetoscopic laser coagulation in both placental tissue and cord plasma, and to investigate differential metabolites pertinent to varying fetal outcomes, including hemodynamic status, birth weight, and cardiac function, of live-born babies. Placental tissue and cord plasma samples from normal term or uncomplicated preterm-born monochorionic twins and those complicated by twin-twin transfusion syndrome treated with or without fetoscopic laser coagulation were analyzed by high-performance liquid chromatography metabolomic profiling. Sixteen comparisons of different co-twin groups were performed. Read More

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Neonatal management and outcome in complicated monochorionic twins: What have we learned in the past decade and what should you know?

Best Pract Res Clin Obstet Gynaecol 2022 Apr 2. Epub 2022 Apr 2.

Division of Neonatology, Willem-Alexander Children's Hospital, Dept. of Pediatrics, Leiden University Medical Center, Leiden, the Netherlands.

Monochorionic (MC) twin pregnancies are at increased risk of neonatal morbidity and mortality due to the shared placenta with vascular connections that can give rise to various complications, including twin-twin transfusion syndrome, twin anemia polycythemia sequence (TAPS), selective fetal growth restriction, and other hematological imbalances at birth. Each complication presents its own challenges and considerations in the neonatal period. Measurement of hemoglobin levels and reticulocyte count is required to establish a correct diagnosis. Read More

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[Autopsies and placental examinations of perinatal fetal deaths: a clinicopathological analysis of 105 cases].

Zhonghua Bing Li Xue Za Zhi 2022 May;51(5):431-436

Department of Pathology, Haidian Maternal and Children Health Hospital, Beijing 100081, China.

To summarize the clinicopathological factors related to perinatal fetal death and to evaluate importance of fetal autopsy and placental pathology. The clinicopathological data of 105 perinatal fetal deaths in Beijing Haidian Maternal and Child Health Hospital from November 2012 to December 2020 were retrospectively analyzed. Relevant literature was also reviewed. Read More

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Robust fetoscopic mosaicking from deep learned flow fields.

Int J Comput Assist Radiol Surg 2022 May 3. Epub 2022 May 3.

Wellcome/EPSRC Centre for Interventional and Surgical Sciences (WEISS) and Department of Computer Science, University College London, London, UK.

Purpose: Fetoscopic laser photocoagulation is a minimally invasive procedure to treat twin-to-twin transfusion syndrome during pregnancy by stopping irregular blood flow in the placenta. Building an image mosaic of the placenta and its network of vessels could assist surgeons to navigate in the challenging fetoscopic environment during the procedure.

Methodology: We propose a fetoscopic mosaicking approach by combining deep learning-based optical flow with robust estimation for filtering inconsistent motions that occurs due to floating particles and specularities. Read More

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Selective versus complete fetoscopic coagulation of vascular equator: a matched comparative study.

Am J Obstet Gynecol 2022 Apr 29. Epub 2022 Apr 29.

From the Department of Obstetrics and Maternal-Fetal Medicine, Hôpital Necker-Enfants Malades, AP-HP and EA7328, Université de Paris, Paris, France (Drs Bartin, Colmant, Bourgon, Ville, Stirnemann and Mrs Carrier).

Background: Complete coagulation of the vascular equator (i.e. 'Solomon' technique) has been suggested to reduce post-operative complications such as twin anemia polycythemia syndrome (TAPS) and recurrence of TTTS following fetoscopic laser coagulation of chorionic vessels for twin-twin transfusion syndrome (TTTS). Read More

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Long-term follow-up of complicated monochorionic twin pregnancies: Focus on neurodevelopment.

Best Pract Res Clin Obstet Gynaecol 2022 Mar 31. Epub 2022 Mar 31.

Willem-Alexander Children's Hospital, Department of Pediatrics, Division of Pediatric Psychology, Leiden University Medical Center, Leiden, the Netherlands.

Monochorionic twin pregnancies have an increased risk of morbidity and mortality. Due to the advancements in screening and treatment strategies, mortality rates have decreased. Improving survival rates demands a shift in scope toward long-term outcomes. Read More

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Management of atypical cases of twin-to-twin transfusion syndrome.

Best Pract Res Clin Obstet Gynaecol 2022 Mar 31. Epub 2022 Mar 31.

Department of Maternal-Fetal Medicine, Hospital Civil de Guadalajara "Dr. Juan I. Menchaca", Jalisco, Mexico.

Up to 20% of monochorionic diamniotic twin pregnancies can be complicated with twin-to-twin transfusion syndrome (TTTS). This complication is diagnosed by ultrasound demonstrating amniotic fluid discordance between both amniotic sacs, with polyhydramnios in the recipient's sac and oligohydramnios in the donor's, secondary to an imbalance in blood volume exchange between twins. Ultrasound evaluation of the amniotic fluid volume, bladder filling, and assessment of fetal Doppler parameters provide the basis for classification of TTTS, allowing severity assessment. Read More

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Monochorionic Diamniotic Twins with Bordering Cord Insertions: Images and Outcome.

Diagnostics (Basel) 2022 Apr 14;12(4). Epub 2022 Apr 14.

National Institute of Mother and Child Care Alessandrescu-Rusescu, 020395 Bucharest, Romania.

Twin pregnancy contributes to perinatal mortality, particularly monochorionic diamniotic twin pregnancy. Placental abnormalities are much more common in twin pregnancies than in singletons. In MCDA pregnancy, vascular anastomoses are always present and are accountable for severe complications such as Twin-to-Twin transfusion syndrome (TTTS). Read More

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Pathophysiology, diagnosis, and management of twin anemia polycythemia sequence in monochorionic multiple gestations.

Best Pract Res Clin Obstet Gynaecol 2022 Mar 30. Epub 2022 Mar 30.

Johns Hopkins Center for Fetal Therapy, Department of Gynecology & Obstetrics, USA.

Twin anemia polycythemia sequence (TAPS) is a consequence of unequal sharing of red blood cells between monochorionic twins resulting in anemia in the donor and polycythemia in the recipient twin. Prenatally TAPS can occur spontaneously or complicate incomplete laser surgery for twin transfusion syndrome. While there may be clinical overlap with twin transfusion syndrome or selective fetal growth restriction, diagnosis relies on Doppler measurement of middle cerebral artery peak systolic velocities. Read More

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Fetoscopic Laser Ablation for the Selective Fetal Reduction in Twin-Twin Transfusion Syndrome Stage II-IV: The Experience of a New Fetal Medicine Center.

Int J Womens Health 2022 14;14:555-563. Epub 2022 Apr 14.

Hanoi Medical University, Hanoi, Vietnam.

Objective: To evaluate the surgery outcomes of fetoscopic laser ablation (FLA) for selective umbilical cord in treating twin-twin transfusion syndrome (TTTS) with special conditions and neonatal outcomes post-operation.

Methods: A prospective study, 21 monochorionic diamniotic (MCDA) twins diagnosed with TTTS stage II-IV according to Quintero classification from 16 to 26 weeks of gestation, among that, 12 cases of TTTS stage II with selective intrauterine growth restriction (sIUGR), 6 cases of TTTS stage II with proximate cord insertions, 3 cases of TTTS stage IV underwent fetoscopic laser ablation for the selective fetal reduction at Hanoi Obstetrics and Gynecology Hospital from September 2019 to July 2021. Complications and surgical outcomes were noted. Read More

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What fetal medicine specialists should know about the monochorionic placenta.

Authors:
Liesbeth Lewi

Best Pract Res Clin Obstet Gynaecol 2022 Mar 30. Epub 2022 Mar 30.

Fetal Medicine Unit, Dept. Obstetrics and Gynecology, University Hospitals Leuven, Herestraat 49, 3000 Leuven, Belgium. Electronic address:

Monochorionic twins are at risk of transfusion imbalances as long as they are connected to the shared placenta during their intrauterine journey. This review article addresses the macroscopic examination of the monochorionic placenta at the time of birth and explains placental dye injection studies to document the vascular anastomoses and placental sharing. We elaborate on the different types of anastomoses, the importance of how the placenta is divided between the twins, and the angioarchitecture in twin-twin transfusion syndrome, twin anemia polycythemia sequence and selective fetal growth restriction. Read More

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Incidence, prognosis, and perinatal outcomes of and risk factors for severe twin-twin transfusion syndrome with right ventricular outflow tract obstruction in the recipient twin after fetoscopic laser photocoagulation.

BMC Pregnancy Childbirth 2022 Apr 15;22(1):326. Epub 2022 Apr 15.

Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Chang Gung University College of Medicine, 5, Fu-Shin Street, Kweishan, Taoyuan, Taiwan, ROC, 333.

Background: Right ventricular outflow tract obstruction (RVOTO) is the most frequently encountered congenital heart disease in patients with twin -twin transfusion syndrome (TTTS) and is especially prevalent in the recipient twin. In this retrospective study, we evaluated the incidence, prognosis, postnatal management, and perinatal outcomes of and risk factors for RVOTO in the recipient twin in severe TTTS cases which diagnosed before 26 weeks after fetoscopic laser photocoagulation (FLP) at a single center in Taiwan.

Methods: RVOTO was diagnosed using fetal or postnatal echocardiography. Read More

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Single fetal demise following fetoscopic ablation for twin-to-twin transfusion syndrome-cohort study, systematic review, and meta-analysis: a response.

Am J Obstet Gynecol 2022 Apr 13. Epub 2022 Apr 13.

Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, 22 South Greene St., Baltimore, MD 21201. Electronic address:

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Single fetal demise following fetoscopic ablation for twin-to-twin transfusion syndrome-cohort study, systematic review and meta-analysis: a comment.

Am J Obstet Gynecol 2022 Apr 13. Epub 2022 Apr 13.

Department of Obstetrics and Gynecology, Gansu Provincial Hospital, Lanzhou, China.

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Proximate Cord Insertion in Twin-to-Twin Transfusion Syndrome: Case Series and PRISMA compliant Systematic Review and Meta-analysis.

Fetal Diagn Ther 2022 Apr 4. Epub 2022 Apr 4.

Objective: We aimed to investigate the prevalence and clinical outcomes of twin-to-twin transfusion syndrome (TTTS) with proximate cord insertions.

Methods: Retrospective cohort study of TTTS cases managed at single fetal center between 2012 and 2020. Presence of proximate cord insertions defined as a distance of equal or less than four centimeters between placental cord insertions that was recorded based on sonographic and fetoscopic examinations. Read More

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Excellent perinatal outcome of monoamniotic twin pregnancy with timely diagnosis and optimal management - a retrospective cohort study.

J Perinat Med 2022 Apr 4. Epub 2022 Apr 4.

Department of Obstetrics and Gynecology, Fetomaternal Mecical Center, Helsinki University Hospital and University of Helsinki, Helsinki, Finland.

Objectives: Monoamniotic twins represent a high-risk pregnancy requiring intense follow-up, elective birth and careful consideration of the mode and timing of delivery. We conducted this study to evaluate the perinatal and neonatal outcomes of monoamniotic twin pregnancies in the largest tertiary hospital in Finland.

Methods: This was a retrospective cohort study including all monoamniotic twin pregnancies during a 17-year period (2002-2018) managed in Helsinki University Hospital. Read More

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Controlled amnioreduction for twin-to-twin transfusion syndrome.

Ther Adv Reprod Health 2022 Jan-Dec;16:26334941221080727. Epub 2022 Mar 29.

Ultrasound Unit in Obstetrics and Gynecology, Lis Maternity Hospital, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.

Background: Twin-to-twin transfusion syndrome (TTTS) is a severe condition causing preterm delivery, fetal death, and neurodevelopmental disorders. This study presents a data-based controlled amnioreduction (AR) protocol composed of sequential amniodrainage in treatment of TTTS.

Methods: A total of 18 procedures were performed in 11 TTTS pregnancies at 17 to 34 weeks of gestation. Read More

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The heart after surviving twin-to-twin transfusion syndrome.

Am J Obstet Gynecol 2022 Mar 26. Epub 2022 Mar 26.

Fetal Medicine Research Center, BCNatal - Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Universitat de Barcelona, and Centre for Biomedical Research on Rare Diseases (CIBER-ER), Barcelona, Spain.

Background: The persistent changes in cardiac structure and function in children who survived twin-to-twin transfusion syndrome remain a matter of concern and controversy. Current fetal echocardiographic parameters and their postnatal evolution can help improve our understanding of the subject.

Objective: To describe the echocardiographic changes of monochorionic fetuses affected by twin-to-twin transfusion syndrome, the recipient and the donor, before and after laser photocoagulation and to determine their evolution in the third trimester and during their first year of life. Read More

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Third Trimester Structural and Diffusion Brain Imaging after Single Intrauterine Fetal Death in Monochorionic Twins: MRI-Based Cohort Study.

AJNR Am J Neuroradiol 2022 Apr 24;43(4):620-626. Epub 2022 Mar 24.

From the Section of Neuroradiology (M.S., B.D., C.H., S.S.)

Background And Purpose: Single intrauterine fetal death increases the risk of antenatal brain lesions in the surviving twin. We evaluated the prevalence of structural brain lesions, biometry, and diffusivity on routine third trimester MR imaging performed following single intrauterine fetal death.

Materials And Methods: In a retrospective MR imaging-based cohort study, we compared 29 monochorionic twins complicated with single intrauterine fetal death (14 following laser ablation treatment for twin-to-twin transfusion syndrome, 8 following selective fetal reduction, and 7 spontaneous) with 2 control cohorts (49 singleton fetuses and 28 uncomplicated twin fetuses). Read More

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Outcome of Monochorionic Pregnancies after Selective Feticide with Bipolar Cord Coagulation: A German Single Center Experience.

J Clin Med 2022 Mar 10;11(6). Epub 2022 Mar 10.

Division of Prenatal Medicine, Gynecological Ultrasound and Fetal Surgery, Department of Obstetrics and Gynecology, University of Cologne, 50937 Cologne, Germany.

Objectives: To review the outcome of complicated monochorionic pregnancies after fetoscopic selective feticide with bipolar cord coagulation in an experienced German center.

Methods: All cases that underwent selective feticide using fetoscopic bipolar umbilical cord occlusion (and simultaneous dissection in monoamniotics) at the University of Bonn in the past 10 years were retrospectively analyzed for antenatal and neonatal course and outcome. An adverse outcome was defined as either intrauterine death (IUD), neonatal death (NND), preterm prelabour rupture of membranes (PPROM), or preterm delivery (PTD) before 32. Read More

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Amyoplasia in monochorionic monozygotic pregnancy following interstitial laser.

Am J Med Genet A 2022 Mar 24. Epub 2022 Mar 24.

Fetal Medicine Department, Indraprastha Apollo Hospital, New Delhi, India.

Amyoplasia is a specific form of arthrogryposis, without any genetic cause. Six to ten percent of amyoplasia cases are one of the monozygotic twins, with the other twin being normal. Failure of maturation of anterior horn cells (AHCs) due to ischemic injury has been postulated as the primary pathological change, leading to arrest in the development of muscle fibers supplied by the affected AHCs with the typical limb positioning seen in amyoplasia. Read More

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Atypical twin-to-twin transfusion syndrome.

Ultrasound Obstet Gynecol 2022 Mar 19. Epub 2022 Mar 19.

Fetal Medicine and Surgery Center, Medicina Fetal Mexico, Quer ́etaro, Mexico.

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Understanding Sociodemographic Disparities in Maternal-Fetal Surgery Study Participation.

Fetal Diagn Ther 2022 10;49(3):125-137. Epub 2022 Mar 10.

National Clinician Scholars Program, Yale School of Medicine and Yale School of Nursing, New Haven, Connecticut, USA.

Background/purpose: Although maternal-fetal surgery to treat fetal anomalies such as spina bifida continues to grow more common, potential health disparities in the field remain relatively unexamined. To address this gap, we identified maternal-fetal surgery studies with the highest level of evidence and analyzed the reporting of participant sociodemographic characteristics and representation of racial and ethnic groups.

Methods: We conducted a systematic review of the scientific literature using biomedical databases. Read More

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Ultrasonographic Diagnosis of Twin-to-Twin Transfusion Syndrome.

Am J Perinatol 2022 Mar 9. Epub 2022 Mar 9.

Obstetrics and Gynecology Department. San Juan de Dios Hospital, Río Negro, Colombia.

Introduction:  Twin-twin transfusion syndrome (TTTS) is a typical complication of monochorionic twin pregnancies (MCTP). Placental vessels that communicate in the chorionic plate between donor and recipient, are responsible for the imbalance of blood flow. Circulatory imbalance causes hypovolemia in donor and hypervolemia in recipient fetus. Read More

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Single fetal demise following fetoscopic ablation for twin-to-twin transfusion syndrome-cohort study, systematic review, and meta-analysis.

Am J Obstet Gynecol 2022 Mar 4. Epub 2022 Mar 4.

Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Maryland School of Medicine, Baltimore, MD. Electronic address:

Background: Several studies have assessed preoperative and operative factors associated with fetal demise after laser for TTTS, yet these findings are not completely conclusive.

Objective: This study aimed to identify risk factors for single fetal demise (recipient and donor twins) after fetoscopic laser photocoagulation for twin-to-twin transfusion syndrome.

Study Design: We searched PubMed, Scopus, and Web of Science systematically from the inception of the database to June 2020. Read More

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Magnetic resonance neuroimaging after laser for twin-twin transfusion syndrome with single fetal demise.

Am J Obstet Gynecol 2022 May 4;226(5):728.e1-728.e8. Epub 2022 Mar 4.

Department of General, Thoracic, and Fetal Surgery, Richard D. Wood Jr Center for Fetal Diagnosis and Treatment, Children's Hospital of Philadelphia, Philadelphia, PA; Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA.

Background: Neurologic injury in the surviving twin is a risk after single fetal demise in a monochorionic pregnancy.

Objective: This study aimed to describe fetal magnetic resonance neuroimaging findings in pregnancies complicated by single fetal demise after laser photocoagulation for twin-twin transfusion syndrome.

Study Design: This was a single-center retrospective analysis of a cohort of prospectively collected patients in a monochorionic twin registry who had fetoscopic laser photocoagulation for twin-twin transfusion syndrome with single fetal demise at follow-up. Read More

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