Ventricular strain changes in monochorionic twins with and without twin-to-twin transfusion syndrome

Differential Changes in Myocardial Performance Index and Its Time Intervals in Donors and Recipients of Twin-to-Twin Transfusion Syndrome before and after Laser Therapy

“…Both IRT and ICT lengthen with increasing cardiac dysfunction leading to higher MPI. Our findings also support previous series reporting that cardiac function is worse in recipients than donors [13-15, 25]. It can be attributable to major changes in preload and afterload that could even lead to hypertrophic cardiomyopathy and right ventricular outflow tract abnormalities [26].…”

Myocardial strain can be measured from first trimester fetal echocardiography using velocity vector imaging

“…Normal strain values have been established for these gestational periods. Strain has also been used to evaluate myocardial function in later gestation fetuses with such conditions as congenital heart defects, twin–twin transfusion, and maternal gestational diabetes mellitus . Strain may also have an advantage over other means of quantifying fetal cardiac function in that it is relatively independent of the angle to the ultrasound beam and therefore does not depend on fetal position.…”

Cardiac function in 10‐year‐old twins following different fetal therapies for twin–twin transfusion syndrome

“…Monochorionic twins are a naturally occurring model in which to study the effects of discordant intrauterine and postnatal epigenetic influences on developmental physiology in genetically identical twins. Cardiac dysfunction is prominent in fetuses with twin–twin transfusion syndrome (TTTS): increased afterload triggers a cycle of events resulting in reduced ventricular strain, increasing volume loading in the recipient fetus, while chronic vasoconstriction in the donor and activation of its renin–angiotensin system contribute to recipient myocardial hypertrophy. Cardiac dysfunction may lead to, or be preceded by, right ventricular outflow tract obstruction abnormalities in about 8% of recipient fetuses, and atrial septal defect has been reported postnatally in about 5%.…”

“…Cardiac dysfunction may lead to, or be preceded by, right ventricular outflow tract obstruction abnormalities in about 8% of recipient fetuses, and atrial septal defect has been reported postnatally in about 5%. Speckle‐tracking studies suggest that reduced left ventricular strain is an early finding in the recipient in pre‐ or early‐stage TTTS while both ventricles are affected in later stage disease, as shown by measurements using a variety of techniques. Following successful therapy by laser ablation, signs of cardiac dysfunction regress in the majority of fetuses before delivery, but there are few reports on the effects of TTTS on cardiac function later in childhood.…”