Potential value of fetal echocardiography in the differential diagnosis of twin pregnancy with presence of polyhydramnios-oligohydramnios syndrome.
OBJECTIVE
Our purpose was to establish whether index values of cardiac performance could discriminate between the twin-twin transfusion syndrome and placental insufficiency as the etiology of the polyhydramnios-oligohydramnios sequence in monochorionic diamniotic twins.


METHODS
Thirteen monochorionic diamniotic twin pregnancies with ultrasonographic evidence of polyhydramnios-oligohydramnios sequence had a complete echocardiography. The etiology was confirmed postnatally: placental insufficiency in eight pairs and the twin-twin transfusion syndrome in five. Intertwin comparisons were made for the following cardiac parameters: cardiothoracic index, end-diastolic thickness of the ventricular walls and septum, aortic and pulmonary artery Doppler peak velocities, ejection and acceleration times, left ventricular shortening fraction, and combined cardiac output and output indexed to fetal weight.


RESULTS
All five recipient twins had thickened ventricular walls. The left ventricular shortening fractions and outputs were significantly increased in the donor twin with twin-twin transfusion syndrome and normal in placental insufficiency.


CONCLUSIONS
In twin-twin transfusion syndrome the donor twin shows evidence of a hyperdynamic cardiac state. Intertwin comparison of cardiac parameters, especially the left ventricular shortening fraction, can be considered a useful tool in diagnosing the different etiologies of the polyhydramnios-oligohydraminos sequence.
Lachapelle
M F
MF
Department of Obstetrics and Gynecology, Sainte-Justine Hospital, University of Montreal, Quebec, Canada.
Leduc
L
L
Côté
J M
JM
Grignon
A
A
Fouron
J C
JC
D000328:Adult; D003937:Diagnosis, Differential; D004200:Diseases in Twins; D004452:Echocardiography; D005260:Female; D005318:Fetal Heart / Q000000981:diagnostic imaging*; D005330:Fetofetal Transfusion / Q000150:complications / Q000000981:diagnostic imaging; D005865:Gestational Age; D006352:Heart Ventricles / Q000196:embryology / Q000473:pathology; D006801:Humans; D008423:Maternal Age; D016104:Oligohydramnios / Q000000981:diagnostic imaging* / Q000209:etiology; D010927:Placental Insufficiency / Q000150:complications / Q000000981:diagnostic imaging; D006831:Polyhydramnios / Q000000981:diagnostic imaging* / Q000209:etiology; D011247:Pregnancy; D013577:Syndrome; D016216:Ultrasonography, Prenatal