Newborn and fetal cardiovascular system in twin-to-twin transfusion syndrome

Relevance. Twin-to-twin transfusion syndrome (TTTS) is associated with fetal cardiovascular disorders carrying the risk of antenatal death and congenital heart disease. Aim. To investigate the effect of TTTS on the fetal cardiovascular system. Materials and methods. The study included 145 pregnant women with monochorionic diamniotic twin pregnancies complicated by TTTS. The participants were divided into two groups based on the Quintero staging: stage I-II (group I, n=100) and stage III-IV (group II, n=45). Myocardial hypertrophy, cardiomegaly, the state of the heart valves, and venous hemodynamics were examined by expert echocardiography. Results. In the whole study cohort, 54.2% of recipient twins had cardiomyopathy. Women with Quintero stage III and IV TTTS were more likely (100%) to have twins with myocardial hypertrophy than those with stage I and II TTTS (73.8%), p=0.001. Recipient twins with cardiomyopathy had a high antenatal mortality rate (19.3%), p=0.01. Cardiomyopathy persisted in 25.4% of newborns from pregnancies affected by TTTS. Conclusion. Cardiomyopathy of the recipient twin is a TTTS complication, which increases in frequency as the disease progresses. The presence of cardiomyopathy increases the risk of antenatal death of the recipient. Surgical correction of TTTS aimed to reverse hemodynamic imbalance may improve fetal cardiac function, which illustrates the adaptability of the developing heart. However, a quarter of surviving recipient twins has cardiomyopathy and remains at risk for pulmonary stenosis.

echocardiography, twin-to-twin transfusion syndrome, monochorionic twins, cardiomyopathy