title: Case report of multiple valve disease found in triplets.
abstract: Valvular heart disease is a multifactorial disorder. Twin studies may help to better understand both genetic and environmental determinants contributing to the development of valve lesions. We describe the case of a 45-year-old female asymptomatic triplet with multiple valvular heart lesions, with a somewhat different pattern between the dizygotic twin pairs compared with the monozygotic twin pair. After thorough assessment of medical history and physical examination, the triplet underwent two- and three-dimensional transthoracic and transesophageal echocardiographic examinations to assess the pathomechanism and severity of their heart valve lesions. The monozygotic twin pair (second-born twin B and third-born twin C) showed the same pattern of valvular lesions: mild mitral, tricuspidal, and aortic regurgitation of the same pathomechanism (posterior mitral valve cleft and aortosclerosis). Interestingly, the examination of first-born twin (twin A), who was dizygotic to twins B and C, revealed mild protosystolic mitral and mild tricuspidal regurgitation, but neither aortic insufficiency nor mitral cleft or indentation could be detected. Beyond the genetic effect, we presume that the intrauterine twinning process might also play a role in the development of congenital valvular heart disease. In order to verify this, further investigation should be performed on larger twin populations. Nevertheless, when one twin is affected, the other asymptomatic twin should also be examined for valvular heart disease.
authors.affiliation: Department of Cardiology,Military Hospital,Budapest,Hungary.
authors.forename: Andrea Á
authors.initials: AÁ
authors.lastname: Molnár
authors.affiliation: Cardiovascular Imaging Research Group,Heart and Vascular Center,Semmelweis University,Budapest,Hungary.
authors.forename: Attila
authors.initials: A
authors.lastname: Kovács
authors.affiliation: Cardiovascular Imaging Research Group,Heart and Vascular Center,Semmelweis University,Budapest,Hungary.
authors.forename: Astrid
authors.initials: A
authors.lastname: Apor
authors.affiliation: Department of Radiology and Oncotherapy,Semmelweis University,Budapest,Hungary.
authors.forename: Adám D
authors.initials: AD
authors.lastname: Tárnoki
authors.affiliation: Department of Radiology and Oncotherapy,Semmelweis University,Budapest,Hungary.
authors.forename: Dávid L
authors.initials: DL
authors.lastname: Tárnoki
authors.affiliation: Cardiovascular Imaging Research Group,Heart and Vascular Center,Semmelweis University,Budapest,Hungary.
authors.forename: Tamás
authors.initials: T
authors.lastname: Horváth
authors.affiliation: Cardiovascular Imaging Research Group,Heart and Vascular Center,Semmelweis University,Budapest,Hungary.
authors.forename: Pál
authors.initials: P
authors.lastname: Maurovich-Horvat
authors.affiliation: Department of Cardiology,Military Hospital,Budapest,Hungary.
authors.forename: Róbert G
authors.initials: RG
authors.lastname: Kiss
authors.affiliation: 3rd Department of Internal Medicine,Bajcsy-Zsilinszky Hospital,Budapest,Hungary.
authors.forename: György
authors.initials: G
authors.lastname: Jermendy
authors.affiliation: Cardiovascular Imaging Research Group,Heart and Vascular Center,Semmelweis University,Budapest,Hungary.
authors.forename: Béla
authors.initials: B
authors.lastname: Merkely
mesh_terms: D004200:Diseases in Twins / Q000000981:diagnostic imaging*; D005260:Female; D006330:Heart Defects, Congenital / Q000000981:diagnostic imaging*; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging*; D006351:Heart Valves / Q000000981:diagnostic imaging; D006801:Humans; D007231:Infant, Newborn; D008875:Middle Aged; D011247:Pregnancy; D059285:Pregnancy, Twin; D014429:Twins, Dizygotic; D014430:Twins, Monozygotic; D014463:Ultrasonography