Congenital heart defects in monochorionic twin pregnancy complicated by selective fetal growth restriction

Faiola, S.; Casati, D.; Stellio, Leonardo Nelva; Laoreti, A.; Corti, Carla; Mannarino, Savina; Lanna, M.; Cetin, Irene

doi:10.1002/uog.26098

Cited by 2 publications

(4 citation statements)

References 27 publications

(37 reference statements)

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“…The onset of RVOTAs before TTTS has not previously been described. However, we recently published cases of RVOTAs in MC pregnancies without TTTS, especially in cases of sFGR with amniotic fluid discrepancies [15,16]. A possible pathophysiologic explanation for these findings is that the uneven and mismatched transfer of blood volume and vasoactive peptides is enough to cause cardiac adaptation without TTTS typically being found; this may develop afterwards, as in the three cases described in the present study.…”

Section: Discussionsupporting

confidence: 51%

Long-Term Postnatal Follow-Up in Monochorionic TTTS Twin Pregnancies Treated with Fetoscopic Laser Surgery and Complicated by Right Ventricular Outflow Tract Anomalies

Faiola

Mandalari

Coco

et al. 2023

JCM

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Right ventricular outflow tract anomalies (RVOTAs), such as pulmonary stenosis (PS), pulmonary atresia (PA), and pulmonary insufficiency (PI), are typical cardiac anomalies in monochorionic twins, and they are complicated by twin-to-twin transfusion syndrome (TTTS). The aim of this study was to conduct a long-term postnatal cardiological evaluation of prenatal RVOTAs in monochorionic diamniotic twin pregnancies complicated by TTTS and treated with fetoscopic laser surgery (FLS) and to analyze possible prenatal predictors of congenital heart disease (CHD). Prenatal RVOTAs were retrospectively retrieved from all TTTS cases treated with FLS in our unit between 2009 and 2019. Twenty-eight prenatal cases of RVOTAs (16 PI, 10 PS, 2 PA) were observed out of 335 cases of TTTS. Four cases did not reach the postnatal period. CHD was present in 17 of the remaining 24 cases (70.8%), with 10 being severe (58.8%; 10/17); nine cases of PS required balloon valvuloplasty, and one case required biventricular non-compaction cardiomyopathy. The risk of major CHD increased with prenatal evidence of PS and decreased with the gestational age at the time of TTTS and with the prenatal normalization of blood flow across the pulmonary valve. Despite treatment with FLS, the majority of monochorionic diamniotic twin pregnancies complicated by TTTS with prenatal RVOTAs had CHD at long-term follow-up.

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Section: Discussionsupporting

confidence: 51%

Long-Term Postnatal Follow-Up in Monochorionic TTTS Twin Pregnancies Treated with Fetoscopic Laser Surgery and Complicated by Right Ventricular Outflow Tract Anomalies

Faiola

Mandalari

Coco

et al. 2023

JCM

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“…Only one study provided data on CHD prevalence in sFGR, reporting a rate of 43.7 per 1000 live births for all CHD (95% CI: 29.0–65.2) in a cohort of 504 liveborn twins 83 . Compared to the CHD prevalence in uncomplicated MC twins, 20 sFGR twins were found to be 2.2 times more likely to be born with a CHD (95% CI: 1.3–3.5; p < 0.001).…”

Section: Resultsmentioning

confidence: 99%

“…In sFGR, RVOTO remained the predominant CHD subtype in the large twins, with a prevalence of 2.6 per 1000 live births (95% CI: 1.2–5.6), representing a 7.7‐fold higher risk compared with uncomplicated MC twins (95% CI: 2.8–21.0; p < 0.001). Notably, eight of the 11 RVOTO cases in sFGR exhibited amniotic fluid discordance, but did not meet the criteria for TTTS 83 . For the small twins, the most prevalent subtype was aortic coarctation, with three cases and a prevalence of 6.0 per 1000 live births (95% CI: 2.0–17.4), which was 13.8 times higher than in uncomplicated MC twins (95% CI 1.4–132.3; p < 0.001).…”

Section: Resultsmentioning

confidence: 99%

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Cardiac adaptation and malformation in twin–twin transfusion syndrome and selective fetal growth restriction: A systematic review

Noll,

Gijtenbeek,

Verweij

et al. 2024

Prenatal Diagnosis

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ObjectivesThis systematic review explores cardiac adaptation in monochorionic (MC) twins with twin–twin transfusion syndrome (TTTS) or selective fetal growth restriction (sFGR) and assesses the risk of congenital heart defects (CHDs).MethodsAdhering to PRISMA guidelines, 63 studies were reviewed (49 on cardiac adaptation, 13 on CHD, one on both). A narrative synthesis of cardiac adaptation patterns was performed. Additionally, a meta‐analysis compared the livebirth prevalence of CHD in TTTS and sFGR against uncomplicated MC twins.ResultsIn TTTS recipients, cardiac function may be impaired for diastolic, systolic, as well as global functions, while in donors, cardiac function is generally preserved. In sFGR, large twins may show hypertrophic cardiomyopathy, and small twins may show impaired systolic function. Co‐occurrence of TTTS and sFGR magnifies cardiac impact but is often underreported. Meta‐analysis for CHD prevalence revealed a relative risk ratio of 3.5 (95% CI: 2.5–4.9) for TTTS and 2.2 (95%CI: 1.3–3.5) for sFGR compared with uncomplicated MC twins.ConclusionsThis study highlights the well‐documented cardiac adaptation in TTTS, contrasting with limited understanding in sFGR. Elevated CHD risks were observed in both conditions. Enhanced cardiovascular surveillance is warranted in complicated MC twin pregnancies. Future research should explore cardiac adaptation in sFGR and its long‐term consequences.

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Congenital heart defects in monochorionic twin pregnancy complicated by selective fetal growth restriction

Cited by 2 publications

References 27 publications

Long-Term Postnatal Follow-Up in Monochorionic TTTS Twin Pregnancies Treated with Fetoscopic Laser Surgery and Complicated by Right Ventricular Outflow Tract Anomalies

Long-Term Postnatal Follow-Up in Monochorionic TTTS Twin Pregnancies Treated with Fetoscopic Laser Surgery and Complicated by Right Ventricular Outflow Tract Anomalies

Cardiac adaptation and malformation in twin–twin transfusion syndrome and selective fetal growth restriction: A systematic review

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