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International Journal of Pediatrics
Volume 2010, Article ID 379792, 8 pages
Review Article

The Fetal Heart in Twin-to-Twin Transfusion Syndrome

University Hospitals Leuven, Division of Woman and Child, Department of Obstetrics and Gynecology, Fetal Diagnosis and Therapy Unit, Herestraat 49, 3000 Leuven, Belgium

Received 9 March 2010; Accepted 12 July 2010

Academic Editor: Shinjiro Hirose

Copyright © 2010 Tim Van Mieghem et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Twin-to-twin transfusion syndrome is a severe complication occurring in 10% of monochorionic twin pregnancies. The disease is usually explained as due to an intrauterine imbalance in intertwin blood exchange, which leads to a volume depleted-donor twin and an overfilled recipient twin. The recipient has signs of cardiac dysfunction, which can be measured using echocardiography or blood and amniotic fluid derived biomarkers. Whereas cardiac dysfunction typically progresses in pregnancies treated with amniodrainage, it usually disappears within a few weeks after fetoscopic laser coagulation of the connecting intertwin anastomoses. Nevertheless, recipients remain at a increased risk of pulmonary stenosis. In this paper, we summarize the cardiac alterations in twin-to-twin transfusion syndrome, describe the changes seen after fetal therapy, list the newly proposed staging systems based on fetal cardiac function, and make recommendations about the use of fetal echocardiography in the evaluation and followup of pregnancies complicated by twin-to-twin transfusion syndrome.