Patient Stories
Twin-Twin Transfusion Syndrome / TTTS
Fetal Surgery Saves Bradley Robert Carlson
Craig and Cathy Carlson live in Geneva, New York. Craig is a 9th grade science teacher. Kathy is a high school librarian. The Carlsons really enjoyed being parents to 2-year-old Jack and were 
elated when they learned they were going to be parents again -- this time with twins. They had no idea that their journey to parenthood would take them all the way to Cincinnati.
At her 20-week ultrasound on August 12, 2004, Cathy expected a routine anatomy check of the babies. But the sonographer told Craig and Cathy that something was wrong, and sent them back to the OB / GYN. The OB, Stephen Achilles, MD, referred them to Strong Memorial Hospital in Rochester, NY, the very next day. (Strong Memorial Hospital is an hour from their home.)
The maternal-fetal medicine specialist, Tulin Ozcan, MD, at Strong Memorial Hospital diagnosed the twins with Twin-Twin Transfusion Syndrome / TTTS -- a condition where the twins share a placenta and there's a connection between the two twins' blood vessels on the placenta. The cause of Twin-Twin Transfusion Syndrome is unknown, and the condition gets progressively worse as the pregnancy continues.
In the case of Twin-Twin Transfusion Syndrome, one twin (the "donor" twin) is smaller with very little amniotic fluid around it. The other twin (the "recipient" twin) is larger and has too much amniotic fluid around it. Over time the recipient twin develops a form of heart failure, while the donor twin stops growing. Without treatment between 80-100 percent of twins with Twin-Twin Transfusion Syndrome die.
At Strong Memorial Hospital, Craig and Cathy learned about Timothy Crombleholme, MD, FACS, FAAP, whom the maternal-fetal specialist recommended. That night, Craig and Cathy visited the Fetal Care Center of Cincinnati web site and read about Dr. Crombleholme and the Fetal Care team.
Craig and Cathy arrived in Cincinnati on August 16, 2004 – an 8-1/2-hour drive from Geneva. They drove through the night.
Upon arrival to the Fetal Care Center of Cincinnati, the Carlsons met with Marsha Corbett, executive secretary for the Fetal Care Center, and reviewed their itinerary for the next two days. Cathy was put through a series of tests and appointments, which included meeting with the Fetal Care Center team. "Marsha was unbelievable," Cathy said. Being teachers, Cathy and Craig liked that everything was so organized. "Everyone was very helpful, very nice," Cathy added.
The team decided the treatment Cathy was receiving at Strong Memorial Hospital was working, so they advised the Carlsons to return to New York and continue with the treatment. Cathy was undergoing amnioreduction treatment to drain the excess amniotic fluid from the sac of the larger, recipient twin (Adam). Dr. Crombleholme kept in touch with the Carlsons' doctor, Eva Pressman, MD, director of Maternal-Fetal Medicine at Strong Memorial, and he monitored Cathy's test results.
About a month later, doctors became alarmed that Adam (the recipient twin) started showing some fluid around his heart. On September 16, 2004, the Carlsons found themselves back in Cincinnati.
Craig and Cathy met with the Fetal Care Center team that same day. The team ran a series of tests to determine that Cathy was physically able to handle surgery.
Cathy was scheduled for surgery at Cincinnati Children's Hospital Medical Center the next morning, Friday, September 17, 2004. The Fetal Care team performed a selective fetoscopic laser photocoagulation, which involved disconnecting the blood vessels shared by the twins using a special surgical laser. Surgeons then performed an amnioreduction to drain some excess amniotic fluid from around Adam (the recipient twin). Cathy was in surgery about two hours.
Following the procedure, Cathy was admitted to the Good Samaritan Hospital Special Care Unit for monitoring. Cathy was under the care of William Polzin, MD, associate director of the Fetal Care Center of Cincinnati. She was released on Saturday, September 18.
The Carlsons and the Fetal Care team thought both babies were doing fine. But during their follow-up appointment, Adam's heart stopped beating, and the team was unable to save him. Cardiologist Erik C. Michelfelder, MD, called Dr. Crombleholme. Both doctors explained to Craig and Cathy that the next 24-48 hours were critical to Bradley (the donor twin). Bradley was carefully monitored to make certain that Adam's death didn't affect him. After 48 hours, the Carlsons returned home to New York.
Once home, Cathy had to visit the maternal-fetal specialist at Strong Memorial Hospital twice a week for an echocardiogram and ultrasound to monitor Bradley.
On November 6, 2004, Cathy started having consistent contractions. The next morning, she knew she was in labor.
At 31 weeks, Cathy gave birth to Bradley Robert at Strong Memorial Hospital. Bradley was in a breech position, so Dr. Pressman performed an urgent C-section. Bradley weighed 2 pounds, 15 ounces. (The doctors at Strong were shocked that Cathy didn't deliver Bradley on the highway, she was that far along with labor.)
Bradley was kept in the NICU at Strong Memorial Hospital for 45 days. He gave everyone a scare in the beginning, when he developed a blood infection that prevented him from maintaining his body temperature. But despite this temporary setback, Bradley gained weight pretty steadily and never required oxygen.
Bradley has developed some problems with his kidneys, which is common for the donor twin. His kidneys will be checked regularly at Strong Memorial, but doctors don't anticipate any long-term problems.
Craig and Cathy were able to bring Bradley home two days before Christmas.
"If the sonographer hadn't been so aware of these things from the beginning, we would have had a terribly different outcome," says Cathy. While it was difficult for Craig and Cathy to pack up and leave their older son at home with family, they're glad they acted when they did. "We had such a good experience in Cincinnati," added Craig and Cathy. "The kind people we met made our situation easier to handle."
Cathy offers this advice to other moms diagnosed with Twin-Twin Transfusion Syndrome: "Act fast. Do everything you can to help both babies."
Craig and Cathy Carlson still live in Geneva, New York, with their two children. Today, Bradley is 3 months old, weighs 6-1/2 pounds and is doing very well. "He's a good baby," says Craig and Cathy. "We're thankful to the Fetal Care Center team every day."
To request an appointment at the Fetal Care Center of Cincinnati or contact us, please use our secure, online appointment form or call 1-888-338-2559 (1-888-FETAL59).
