Fetal Doppler in monochorionic pregnancies complicated by twin-to-twin transfusion syndrome and selective in utero growth restriction

Diagnostic and therapeutic precision in cardiovascular diseases in the neonatal intensive care

While patent ductus arteriosus, pulmonary hypertension, and systemic hypotension are key medical issues amongst neonates, there are other common biological conditions which present with distinct physiological diagnostic and therapeutic challenges. This review focuses on such hemodynamic considerations in cardiomyopathy accompanying infants of diabetic mothers, twin-to-twin transfusion syndrome, and left heart pathology in infants with severe chronic lung disease. It details the pathophysiological mechanisms, diagnostic approaches, and therapeutic strategies essential for optimizing cardiovascular stability in this fragile cohort. A regimented, protocol-driven approach may lead to an increased risk of unintended treatment side effects in patients where diagnostic precision is low. This review provides a rational basis of the management of hemodynamic instability, at the same time laying out knowledge gaps and considerations for future research.

Cardiac function and neurological development in complicated monochorionic pregnancies: Current evidence and clinical implications

Monochorionic twin pregnancies, characterized by a shared placenta and unique vascular architecture, face significantly elevated risks of perinatal complications compared to dichorionic and singleton pregnancies. This review examines the pathophysiology, cardiovascular, and neurological adaptations in three primary complications of monochorionic pregnancies: Twin-to-Twin Transfusion Syndrome (TTTS), Selective Fetal Growth Restriction (sFGR), and Twin Anemia Polycythemia Sequence (TAPS). TTTS disrupts hemodynamic balance, leading to distinct cardiac dysfunctions and increased neurodevelopmental injury (NDI). In sFGR, unequal placental sharing induces cardiovascular and neurological disparities between twins, while TAPS causes chronic anaemia and polycythemia with associated risks of brain injury. Advances in fetal therapy, such as fetoscopic laser surgery, have significantly improved survival, yet long-term sequelae remain concerning. This review emphasizes the importance of specialised prenatal care, multidisciplinary management, and comprehensive postnatal follow-up to mitigate adverse outcomes. The findings call for further research into the mechanisms of fetal adaptation and injury, aiming to refine diagnostic tools and therapeutic strategies.

Cardiac adaptation and malformation in twin-twin transfusion syndrome and selective fetal growth restriction: A systematic review

OBJECTIVES

This systematic review explores cardiac adaptation in monochorionic (MC) twins with twin-twin transfusion syndrome (TTTS) or selective fetal growth restriction (sFGR) and assesses the risk of congenital heart defects (CHDs).

METHODS

Adhering to PRISMA guidelines, 63 studies were reviewed (49 on cardiac adaptation, 13 on CHD, one on both). A narrative synthesis of cardiac adaptation patterns was performed. Additionally, a meta-analysis compared the livebirth prevalence of CHD in TTTS and sFGR against uncomplicated MC twins.

RESULTS

In TTTS recipients, cardiac function may be impaired for diastolic, systolic, as well as global functions, while in donors, cardiac function is generally preserved. In sFGR, large twins may show hypertrophic cardiomyopathy, and small twins may show impaired systolic function. Co-occurrence of TTTS and sFGR magnifies cardiac impact but is often underreported. Meta-analysis for CHD prevalence revealed a relative risk ratio of 3.5 (95% CI: 2.5-4.9) for TTTS and 2.2 (95%CI: 1.3-3.5) for sFGR compared with uncomplicated MC twins.

CONCLUSIONS

This study highlights the well-documented cardiac adaptation in TTTS, contrasting with limited understanding in sFGR. Elevated CHD risks were observed in both conditions. Enhanced cardiovascular surveillance is warranted in complicated MC twin pregnancies. Future research should explore cardiac adaptation in sFGR and its long-term consequences.