title: The twin-twin transfusion syndrome: spectrum of cardiovascular abnormality and development of a cardiovascular score to assess severity of disease.
abstract: OBJECTIVE
  Current means of grading twin-twin transfusion syndrome does not characterize cardiovascular aspects adequately. We sought to develop a score that describes the magnitude of cardiovascular severity in twin-twin transfusion syndrome.
  
  
  METHODS
  Fetal echocardiograms of 150 monochorionic/diamniotic twins were reviewed. Blinded to Quintero stage, we applied a cardiovascular score to each twin set and compared it to the Quintero grade. The score is a composite of variables that include ventricular hypertrophy, dilation, function, valve regurgitation, great artery size, and diastolic properties in the recipient and umbilical artery flow in the donor. Doppler indices of vascular and ventricular function were measured.
  
  
  RESULTS
  Mean age was 21 +/- 3 weeks. Discrepancy was noted in degree of severity between Quintero and cardiovascular stages. The score correlated well with myocardial performance index of the recipient right ventricle (r2 = .65).
  
  
  CONCLUSIONS
  We describe the spectrum of cardiovascular abnormalities that are seen in twin-twin transfusion syndrome and propose a scoring system for assessment of severity.
authors: Fetal Heart Program, Children's Hospital of Philadelphia, Philadelphia, PA 19104, USA. rychik@email.chop.edu
authors: Jack
authors: J
authors: Rychik
authors: Zhiyun
authors: Z
authors: Tian
authors: Michael
authors: M
authors: Bebbington
authors: Feng
authors: F
authors: Xu
authors: Margaret
authors: M
authors: McCann
authors: Stephanie
authors: S
authors: Mann
authors: R Douglas
authors: RD
authors: Wilson
authors: Mark P
authors: MP
authors: Johnson
mesh_terms: D018376:Cardiovascular Abnormalities / Q000000981:diagnostic imaging*; D004200:Diseases in Twins / Q000000981:diagnostic imaging*; D015150:Echocardiography, Doppler; D005260:Female; D005330:Fetofetal Transfusion / Q000000981:diagnostic imaging*; D006801:Humans; D011247:Pregnancy; D012189:Retrospective Studies; D014427:Twins; D016216:Ultrasonography, Prenatal