Congenital heart disease in monochorionic twins with and without twin-to-twin transfusion syndrome.
OBJECTIVE
This study aims to evaluate the prevalence of congenital heart disease (CHD) in monochorionic (MC) twin pregnancies with and without twin-to-twin transfusion syndrome (TTTS) in an unselected cohort, which underwent prenatal and postnatal echocardiography.


METHODS
This was a retrospective cohort study including 451 MC twin pregnancies between 2002 and 2012. Complete outcome data were available for 381 pregnancies. All patients had prenatal echocardiography, and postnatal echocardiography was performed in all newborns with symptoms or to follow-up on prenatal findings. Data from prenatal and postnatal echocardiography and autopsy were analyzed. The classification of Houyel et al. was used for structural CHD.


RESULTS
Structural CHD was diagnosed in 5.5% of all MC twins (42/762). Twins with TTTS showed a significant higher rate of CHD than unaffected twins (9.3% vs 4.7%; p = 0.03). Prenatal detection rate of CHD was 48%. Most common abnormalities were ventricular septal defects (VSD) (2.1%) followed by anomalies of the ventricular outflow tracts (1.3%) in the overall population and VSD (2.9%) and anomalies of the great arteries (2.9%) in the group with TTTS.


CONCLUSIONS
MC twin pregnancies show a high prevalence of structural CHD (5.5%), especially those affected by TTTS. A detailed prenatal and postnatal echocardiography could be considered in these pregnancies.
Department of Obstetrics and Feto-Maternal Medicine, Medical University of Vienna, Vienna, Austria.
Stephanie
S
Springer
Elisabeth
E
Mlczoch
Elisabeth
E
Krampl-Bettelheim
Mariella
M
Mailáth-Pokorny
Barbara
B
Ulm
Christof
C
Worda
Katharina
K
Worda
D000328:Adult; D001317:Austria / Q000453:epidemiology; D006332:Cardiomegaly / Q000151:congenital* / Q000453:epidemiology; D024741:Cardiomyopathy, Hypertrophic, Familial / Q000453:epidemiology / Q000209:etiology*; D015331:Cohort Studies; D005260:Female; D005330:Fetofetal Transfusion / Q000150:complications* / Q000453:epidemiology; D006801:Humans; D011247:Pregnancy; D015995:Prevalence; D012189:Retrospective Studies; D014430:Twins, Monozygotic; D055815:Young Adult