The influence of twinning on cardiac development

Manning, Nicky

doi:10.1016/j.earlhumdev.2008.01.009

Cited by 37 publications

(41 citation statements)

References 27 publications

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“…The previous literature suggests that monochorionicity is the key risk factor for congenital heart defects in twins and TTTS-affected monochorionic twins in particular. [1][2][3] However, our study showed an increased congenital heart defect risk in both monozygotic twins (35%; 95% CI, 1-81%) and dizygotic twins (30%; 95% CI, 13-51%) compared with singletons. The highest risk was found for the approximately one quarter of the twins for whom zygosity was unknown.…”

Section: Discussioncontrasting

confidence: 55%

“…[1][2][3][4][5] All monochorionic twins are monozygotic, and they comprise approximately two thirds of all monozygotic twins, whereas all dizygotic twins and the remaining one third of monozygotic twins are dichorionic. 3,6 Some congenital heart defects are clearly expected to be more frequent in twins. The acardiac twin (together with a pump or donor twin) represents a congenital heart defect unique for monozygotic twins, although rare, with a frequency of ≈1 in 50 to 70 000 deliveries and 1 in 200 to 280 monozygotic twins.…”

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confidence: 99%

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Increased Prevalence of Congenital Heart Defects in Monozygotic and Dizygotic Twins

2013

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Background-Smaller studies and many case series reports indicate that congenital heart defects may be more common in monochorionic twins than in dichorionic twins and singletons. Methods and Results-We investigated congenital heart defect occurrence in all twins and 5% of all singletons born in Denmark in 1977-2001 and followed through 2006 by linking the Danish Twin Registry and Statistics Denmark registers including the National Medical Birth Register and the Danish National Patient Register. Among 41 525 twin individuals, a total of 584 twins (1.4%) had a congenital heart defect registered in the Danish National Patient Register, whereas the corresponding numbers for singletons were 648 of 74 473 (0.87%; P<0.001; ie, a 63% [95% confidence interval, 45-82%] increased risk for congenital heart defect for twins). Patent ductus arteriosus and coarctation of aorta occurred >3 times as often in twins as in singletons, at 3.9 (95% confidence interval, 2.6-5.8) and 3.1 (95% confidence interval, 1.5-6.4), respectively. The increased occurrence in twins was also found in sensitivity analyses including only inpatients or only surgically treated cases regardless of whether preterm patent ductus arteriosus was included. We were not able to demonstrate a higher risk for congenital heart defect among monozygotic twins compared with dizygotic twins, and the congenital heart defect occurrence was also increased in dizygotic twins, who are all dichorionic. Conclusions-Congenital heart defect is more common in twins than in singletons, and the increased occurrence is not restricted to monochorionic twins. Intrauterine surveillance and a postnatal comprehensive cardiac assessment for both twins may be considered regardless of chorionicity and zygosity. (Circulation. 2013;128:1182-1188.)

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Section: Discussioncontrasting

confidence: 55%

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confidence: 99%

Increased Prevalence of Congenital Heart Defects in Monozygotic and Dizygotic Twins

2013

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“…Conjoined twins often have laterality defects and cardiac abnormalities (Levin et al, 1996;Manning, 2008), revealing that primary axes in the same blastoderm interact functionally with respect to LR patterning. However, earlier data revealed only confounding cross-talk between twins at primitive streak stages.…”

Section: Late Organizers Can Properly Orient Lr Asymmetries If Instrmentioning

confidence: 99%

Consistent left-right asymmetry cannot be established by late organizers inXenopusunless the late organizer is a conjoined twin

Vandenberg

Levin

2010

Development

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SUMMARYHow embryos consistently orient asymmetries of the left-right (LR) axis is an intriguing question, as no macroscopic environmental cues reliably distinguish left from right. Especially unclear are the events coordinating LR patterning with the establishment of the dorsoventral (DV) axes and midline determination in early embryos. In frog embryos, consistent physiological and molecular asymmetries manifest by the second cell cleavage; however, models based on extracellular fluid flow at the node predict correct de novo asymmetry orientation during neurulation. We addressed these issues in Xenopus embryos by manipulating the timing and location of dorsal organizer induction: the primary dorsal organizer was ablated by UV irradiation, and a new organizer was induced at various locations, either early, by mechanical rotation, or late, by injection of lithium chloride (at 32 cells) or of the transcription factor XSiamois (which functions after mid-blastula transition). These embryos were then analyzed for the position of three asymmetric organs. Whereas organizers rescued before cleavage properly oriented the LR axis 90% of the time, organizers induced in any position at any time after the 32-cell stage exhibited randomized laterality. Late organizers were unable to correctly orient the LR axis even when placed back in their endogenous location. Strikingly, conjoined twins produced by late induction of ectopic organizers did have normal asymmetry. These data reveal that although correct LR orientation must occur no later than early cleavage stages in singleton embryos, a novel instructive influence from an early organizer can impose normal asymmetry upon late organizers in the same cell field.

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“…8 Relatively deoxygenated blood from the pump fetus travels backwards through the anastomoses and reaches the second fetus whose lower body is oxygenated but who presents with secondary atrophy of the heart and other organs located in the upper part of the body. 3,[9][10][11] Acardiac fetuses may present limb movement due to intact spinal reflexes, which make the diagnosis of fetal death uncertain. Gimenes-Scherer and Davies have described numerous anomalies: The number of affected organs decreases in the craniocaudal direction, the head and upper limbs are most severely affected and the distal segments of the limbs are often missing.…”

Section: Discussionmentioning

confidence: 99%

Advances in Ultrasonic Assessment of Acardiac Twin

Stamatian¹,

Mureşan²,

Caracostea³

et al. 2011

Donald School Journal of Ultrasound in Obstetrics and Gynecology

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The development of an acardiac anomaly, one of the most severe human malformations, is a rare complication unique to monochorionic multiple pregnancies. In this condition, the primary malformation is the lack of a well-defined cardiac structure in one twin (the acardiac twin), which is kept alive by its structurally normal co-twin (the pump twin).The final diagnosis for a twin pregnancy with an acardiac twin may be established after the 9th week, when the cephalic extremity and limbs can be precisely determined.Direct signs that lead to the diagnosis of an acardiac twin include the absence of cardiac and fetal movements, difficult visualization of the trunk and cephalic poles, thickening of subcutaneous tissue and the presence of umbilical artery reverse flow towards the acardiac fetus mass. The pump fetus may demonstrate hydramnios, cardiomegaly and heart failure.Once an acardiac anomaly is diagnosed, both the acardiac and pump twins should be assessed to classify the pregnancy according to prognostic factors based on the size and growth of the acardiac twin and the cardiovascular condition of the pump twin. Assessing the extent of heart damage in the pump fetus is a key step in pregnancy management.There are two available options, either conservative or interventional, for the management of these pregnancies. Serial ultrasound surveillance is important for detecting any worsening of the condition, which may suggest the need for interventions to optimize the pump-twin's chance for survival.We performed a retrospective analysis of three cases of monochorionic twin pregnancies diagnosed with a twin reversed arterial perfusion (TRAP) sequence during the first and second trimesters. We compared our data with those offered by a review of the literature.

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The influence of twinning on cardiac development

Cited by 37 publications

References 27 publications

Increased Prevalence of Congenital Heart Defects in Monozygotic and Dizygotic Twins

Increased Prevalence of Congenital Heart Defects in Monozygotic and Dizygotic Twins

Consistent left-right asymmetry cannot be established by late organizers inXenopusunless the late organizer is a conjoined twin

Advances in Ultrasonic Assessment of Acardiac Twin

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