The twin-twin transfusion syndrome: spectrum of cardiovascular abnormality and development of a cardiovascular score to assess severity of disease

Ultrasound assessment of fetal cardiac function

“…Several groups have suggested scoring systems, 3 , 7 which combine methods of assessment to provide a more global overview of cardiac function and which could be used as a prognostic marker or to define heart failure. Although scoring may be superior to single measurements in defining compromised cardio‐circulatory function, there are still many limitations to the incorporation of the proposed scores in clinical practice.…”

“…Currently, the field of fetal cardiology is developing rapidly and fetal echocardiography is used not only for detection of structural anomalies 1 , 2 but also to assess fetal cardiac function 3 4 Although fetuses rarely go into cardiac failure, the implementation of new cardiac technologies allows identifying subtle changes in cardiac function in subclinical phase 4 …”

“…Ejection fraction is defined as the percentage of blood ejected in each heart cycle. In order to calculate it the diameters are elevated to a cube to estimate ventricular volumes as: (EDD 3 –ESD 3 )/EDD 3 . Normal values in the fetus have been published 36 .…”

Role of quantitative assessment in fetal echocardiography

“…Caution, however, must be exercised in the use of a uniform scoring system for different disease states, as has been proposed for the cardiovascular score developed for fetal heart failure 23,24 and a recent modification and application of this score to TTTS recipient and donor twins 25 . Although the cardiovascular score for heart failure correlates with fetal loss among highrisk pregnancies, it has been used for both primary cardiac disease 24 , in which myocardial dysfunction leads to worse outcome, and for placental insufficiency 25 , in which fetal hypoxia is the trigger for late and often acute onset (secondary) reduced myocardial function.…”

“…Although the cardiovascular score for heart failure correlates with fetal loss among highrisk pregnancies, it has been used for both primary cardiac disease 24 , in which myocardial dysfunction leads to worse outcome, and for placental insufficiency 25 , in which fetal hypoxia is the trigger for late and often acute onset (secondary) reduced myocardial function. Doppler indices may reflect different myocardial disease states and even abnormalities of vascular function, umbilical venous return and loading conditions of the fetal heart.…”