Diastolic Dysfunction and Cerebrovascular Redistribution Precede Overt Recipient Twin Cardiomyopathy in Early-Stage Twin-Twin Transfusion Syndrome

Fetal left modified myocardial performance index measured by the Auto Mod-MPI system: development of reference values and application to recipients of twin-to-twin transfusion syndrome

“…Divanović et al reported increased IRT in recipients, and this change was more significant in advanced‐stage TTTS . The same study group further confirmed that the diastolic dysfunction was evident before the findings of overt cardiomyopathy, even in early stage . To our knowledge, there have been no studies of changes in recipient systolic function.…”

“…The increases in ICT and IRT but not ET can be interpreted as myocardial impairment of both contraction and relaxation with shortening of the diastolic filling time. Although several studies have evaluated cardiac dysfunction in recipients using Mod‐MPI, only a few reports have assessed its components, mainly focusing on the diastolic function . Divanović et al reported increased IRT in recipients, and this change was more significant in advanced‐stage TTTS .…”

First-Trimester Ultrasound

“…The usefulness in early gestation is less obvious [152]. The issue was addressed long ago [153] but the practice has been opposed by various authors and professional, scientific organizations [154][155][156][157][158][159][160][161][162][163][164], although not by all [165] and with difference of opinions on whether practitioners involved in this activity should be sanctioned [166]. As determined by TI and MI, acoustic output during 3D/4D exams does not seem excessive [75].…”

“…Differences in ductus venosus Doppler waveforms between twins has also been described as an early warning sign for subsequent development of TTTS [ 162 , 163 ]. Diastolic myocardial dysfunction occurs early in the pathophysiology of TTTS [ 164 ] and, together with cerebroplacental redistribution precede fi ndings of overt cardiomyopathy [ 165 ]. While AA and VV anastomoses are on the surface of the placenta, AV and VA are deeper in the placental substance.…”

Test–retest variability for quantitative two‐dimensional and Doppler measurements in the fetus

“…ment. It is somewhat surprising that the Doppler MPI is so variable between testers, particularly given our center's substantial experience in the measurement of MPI in fetuses [12][13][14][15]. In comparison, the intra-observer percent mean difference and inter-observer percent mean difference were all <10% (with the exception of pulmonary vein VTI).…”