Dr. Mari Demonstrates New Technology That Gives Twins the Gift of Life

Excitement about choosing nursery colors and the perfect names can too quickly turn into a nightmare for expectant mothers who are pregnant with identical twins. Nearly 15 percent of identical twins will develop Twin-to- Twin Transfusion Syndrome (TTTS) in the womb — and when it is left untreated, this condition has a 100 percent mortality rate.

“If we see this syndrome, and nothing is done, both twins will die,” says Dr. Giancarlo Mari, the Medical Director of the High-Risk Obstetrics Program at Regional One Health. TTTS only affects identical twins. Because they share the same placenta, there is the possibility that the amniotic fluid in the womb might not be evenly distributed between the twins. This is often the first sign that the twins have developed shared blood vessels, with one twin sending blood to the other, leading to an imbalance that causes the death of both twins.

“There are two ways to treat TTTS,” Dr. Mari says. “First, obstetricians might try to adjust the levels of amniotic fluid in the womb, evening out its distribution between the twins. Sometimes, if you level out the amniotic fluid once, the babies will be healthy.”

However, this procedure doesn’t always work. In that case, the only option left to save the twins’ lives is a complex laser surgery performed with a tool that has a 2 millimeter endoscope, which is used on the twins while they are still in the womb. Dr. Mari at Regional One Health is one of the few specialists in the United States who performs this intrauterine surgery on twins.

Currently, there are only 10 centers in the United States performing this surgery, and Regional One Health is the only hospital with this capability within 700 miles of Memphis.

“There are still issues, risks and complications, even after this surgery,” Dr. Mari says, “but it is the best form of therapy we have today for TTTS.” During the surgery, Dr. Mari must remain highly focused and precise. Even if only one blood vessel is still shared, the twins will die.

Dr. Mari was trained on TTTS treatments early in his career, but Regional One Health did not always have the life-saving equipment he needed to perform these intrauterine surgeries.

It wasn’t until Regional One Health Foundation purchased the equipment he needed, with the generous donations of local philanthropists, that Dr. Mari was able to use his skills and training to save these vulnerable lives.

“It isn’t needed every day,” says Tammie Ritchey, Vice President of Development, “but now there is a place here in this region for these patients.”

Before Regional One Health Foundation purchased this equipment for the hospital, the closest options for patients in the Mid- South were located in Florida and Ohio. “We just couldn’t imagine how that must feel,” Ritchey says. “Imagine finding out that both of your babies will die without surgery, and then you have to travel to another state, without your family or support network. We knew that Regional One Health Foundation could truly make a difference for patients in our region with this investment.”

Recently, Dr. Mari successfully performed this surgery on twins with TTTS who were ultimately both born healthy and happy. “Delivering those twins was a joy that is difficult to describe,” Dr. Mari says. “It’s just an immense joy.”

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