Cardiac dysfunction in twin-twin transfusion syndrome: a prospective, longitudinal study

Area of Science:

• Perinatology
• Cardiology
• Fetal Medicine

Background:

• Twin-twin transfusion syndrome (TTTS) is a serious complication of monochorionic twin pregnancies.
• Cardiac dysfunction is increasingly recognized in TTTS, but its course and long-term implications require further investigation.

Purpose of the Study:

• To prospectively evaluate cardiac dysfunction in TTTS using serial echocardiography.
• To determine the clinical course and perinatal outcomes associated with prenatal cardiac abnormalities in TTTS.

Main Methods:

• Serial fetal echocardiography was performed on twin pregnancies diagnosed with TTTS in the second trimester.
• Assessments included cardiac anatomy, chamber size, ventricular function, and atrioventricular valve regurgitation.
• Postnatal echocardiograms were obtained for surviving infants.

Main Results:

• Prenatal cardiac dysfunction was observed in 10 out of 12 recipient twins; donor twins had normal assessments.
• Common abnormalities in recipient twins included decreased ventricular function, tricuspid regurgitation, and chamber enlargement.
• Seven recipient twins showed deteriorating cardiac function with advancing gestation, and four survivors had persistent postnatal abnormalities.

Conclusions:

• Prenatal cardiac dysfunction is prevalent in recipient twins with TTTS.
• The cardiac dysfunction can manifest as transient, progressive, or persistent conditions beyond the neonatal period.
• Serial echocardiography is crucial for monitoring and understanding the cardiac impact of TTTS.