Twin–twin transfusion syndrome: don't rely on fluids and bladders to catch it early

Congenital heart defects in monochorionic twin pregnancy complicated by selective fetal growth restriction

“…This phenotype is characterized by the uneven and mismatched passage of vasoactive mediators and fluid through placental anastomoses, causing cardiac adaptation in the recipient fetus, with increasing intracardiac filling pressures and diastolic dysfunction, thereby increasing fluid volume in the larger twin and decreasing it in the smaller twin, without developing frank TTTS. Recent publications have shown that signs of cardiac dysfunction, such as a shortening of early diastolic filling time, can appear days before the development of TTTS 15,16 . AFD was transient in all of our cases, with normalization of amniotic fluid volume after several weeks, but left permanent organ damage due to cardiovascular dysfunction.…”

A Comprehensive Review on Twin-twin Transfusion Syndrome Diagnosis and Treatment

“…The excessive amount of amniotic fluid transfer can severely affect the heart performance and lead to pulmonary atresia in the recipient twin [9][10][11][12].…”

Atypical twin–twin transfusion syndrome

“…Unlike in TTTS cases with sFGR, selective reduction does not appear to be a reasonable option, as the majority of these functional lesions disappear after laser therapy with no sequelae. It has been proposed that there is a need to explore the role of intertwin pair discordance in cardiovascular parameters, as an early marker of cardiovascular dysfunction, in informing management decisions 26 .…”