title: Pulmonary stenosis in complicated monochorionic twin pregnancies: prevalence, management and outcome.
abstract: OBJECTIVE
  To review prevalence, management and prognostic factors of pulmonary stenosis (PS) in monochorionic diamniotic (MCDA) pregnancies complicated by twin-to-twin transfusion syndrome (TTTS).
  
  
  METHODS
  Retrospective study over the last 10 years in a single referral center. We reviewed fetal echocardiography data of all MC twin cases with diagnosis of isolated PS. We assessed fetoscopy characteristics of those that underwent laser coagulation. We collected data regarding perinatal outcome, neonatal echocardiography and cardiac management.
  
  
  RESULTS
  We found 24 cases of isolated PS among 2091 MCDA pregnancies. Among 1052 complicated MCDA that underwent fetal laser surgery, 22 (2.09%) developed PS of which 20 were diagnosed prenatally. Two cases were diagnosed in uncomplicated MCDA pregnancies (0.2%). Four of 22 (18.18%) cases with TTTS showed in utero regression after laser treatment. Thirteen newborns (65%) required valvular dilatation. Peak systolic velocities in the pulmonary artery trunk (PSV-PA) at diagnosis and the interval between the diagnosis of TTTS and that of PS were significantly different (p < 0.001 and p = 0.05 respectively) between PS requiring cardiac intervention and those who did not.
  
  
  CONCLUSIONS
  An elevated PSV-PA at the time of PS diagnosis and a short time-interval between fetoscopic laser surgery and PS diagnosis are predictive of the need for interventional treatment after birth.
authors.affiliation: National Referral Centre for Twin-to-Twin Transfusion Syndrome, Paris-Descartes University, Necker-Enfants-Malades Hospital, APHP, Paris, France.|Obstetrics and Fetal Medicine Department, Necker-Enfants-Malades Hospital, APHP, Paris V University, Paris, France.|Maternal Fetal Medicine Unit, University of Brescia, Spedali Civili di Brescia, Brescia, Italy.
authors.forename: V
authors.initials: V
authors.lastname: Stagnati
authors.affiliation: National Referral Centre for Twin-to-Twin Transfusion Syndrome, Paris-Descartes University, Necker-Enfants-Malades Hospital, APHP, Paris, France.|Obstetrics and Fetal Medicine Department, Necker-Enfants-Malades Hospital, APHP, Paris V University, Paris, France.
authors.forename: G E
authors.initials: GE
authors.lastname: Chalouhi
authors.affiliation: National Referral Centre for Twin-to-Twin Transfusion Syndrome, Paris-Descartes University, Necker-Enfants-Malades Hospital, APHP, Paris, France.|Obstetrics and Fetal Medicine Department, Necker-Enfants-Malades Hospital, APHP, Paris V University, Paris, France.
authors.forename: M
authors.initials: M
authors.lastname: Essaoui
authors.affiliation: Neonatology Department, Necker-Enfants-Malades Hospital, APHP, Paris V University, Paris, France.
authors.forename: A
authors.initials: A
authors.lastname: Giuseppi
authors.affiliation: National Referral Centre for Twin-to-Twin Transfusion Syndrome, Paris-Descartes University, Necker-Enfants-Malades Hospital, APHP, Paris, France.|Obstetrics and Fetal Medicine Department, Necker-Enfants-Malades Hospital, APHP, Paris V University, Paris, France.
authors.forename: J J
authors.initials: JJ
authors.lastname: Stirnemann
authors.affiliation: Pediatric Cardiology Department, Necker-Enfants-Malades Hospital, APHP, Paris V University, Paris, France.
authors.forename: J
authors.initials: J
authors.lastname: Le Bidois
authors.affiliation: National Referral Centre for Twin-to-Twin Transfusion Syndrome, Paris-Descartes University, Necker-Enfants-Malades Hospital, APHP, Paris, France.|Obstetrics and Fetal Medicine Department, Necker-Enfants-Malades Hospital, APHP, Paris V University, Paris, France.
authors.forename: Y
authors.initials: Y
authors.lastname: Ville
mesh_terms: D000650:Amnion / Q000000981:diagnostic imaging*; D002823:Chorion / Q000000981:diagnostic imaging*; D019468:Disease Management; D004452:Echocardiography; D005260:Female; D005330:Fetofetal Transfusion / Q000453:epidemiology*; D005332:Fetoscopy; D006801:Humans; D007231:Infant, Newborn; D017075:Laser Coagulation; D053685:Laser Therapy; D011247:Pregnancy; D059285:Pregnancy, Twin; D015995:Prevalence; D011379:Prognosis; D011651:Pulmonary Artery / Q000000981:diagnostic imaging*; D011666:Pulmonary Valve Stenosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000628:therapy; D012189:Retrospective Studies; D016896:Treatment Outcome; D014430:Twins, Monozygotic; D016216:Ultrasonography, Prenatal