[Aortic coarctation in the recipient in TTTS--diagnostic problems--a case report]

Area of Science:

• Cardiology
• Fetal Medicine
• Medical Imaging

Background:

• Twin-to-twin transfusion syndrome (TTTS) presents unique hemodynamic challenges.
• Aortic coarctation is a congenital heart defect affecting blood flow from the heart.
• The coexistence of TTTS and aortic coarctation is rare and complicates diagnosis.

Observation:

• Prenatal diagnosis of aortic coarctation relies on ventricular size assessment and mediastinal great vessel disparity.
• Doppler studies revealing continuous flow through the aortic isthmus or a "coarctation shelf" suggest the defect.
• In this case, the recipient twin exhibited hypervolemia and right heart strain, complicating coarctation diagnosis.

Findings:

• Aortic coarctation was diagnosed in the recipient twin with TTTS.
• Hemodynamic disturbances and Doppler parameters were monitored during therapeutic interventions like amnioreduction and fetoscopy.
• Right heart volume overload and hypertrophy associated with TTTS can mask aortic coarctation.

Implications:

• Accurate prenatal diagnosis of aortic coarctation in TTTS requires careful assessment of multiple echocardiographic and Doppler parameters.
• Therapeutic interventions for TTTS can impact fetal cardiovascular hemodynamics, necessitating close monitoring.
• Understanding these complex interactions is crucial for effective management and improved fetal outcomes.