G255(P) Aortic and pulmonary artery calcification in twin-to-twin transfusion syndrome

Abstract

Introduction Twin-to-twin transfusion syndrome (TTTS) is a rare disorder occurring as a result of communicating vascular anastomosis between the circulations of one twin with that of the other. Cardiac findings in this condition may include ventricular hypertrophy, pulmonary stenosis, tricuspid regurgitation, congestive cardiac failure, left ventricle hypoplasia with hypokinesia, and sub-aortic obstruction seen in the recipient twin. Isolated great artery calcification; aortic and pulmonary artery calcification is one such uncommon condition associated with TTTS. It may cause severe systemic hypertension and cardiomyopathy. We report a case of aortic and pulmonary artery calcification in association with TTTS Case report The twins were born at 34+4 weeks of gestation by elective caesarean in good condition. There was an antenatal diagnosis of TTTS, treated with laser ablation of the recipient twin (Twin 1). Twin 1 had an antenatal diagnosis of pulmonary stenosis and pericardial effusion. Echocardiogram done postnatally in the first day of life showed a structurally normal heart with pericardial effusion. The aortic valve was bicuspid with an echogenic post aortic valve stenosis and the ascending aorta. Pulmonary valve was echogenic with a clear post pulmonary valve stenosis a post stenotic dilatation. The pulmonary arteries looked small bilaterally with a flow velocity of approximately 1.7 m/sec. Serial echocardiogram in the neonatal unit showed no increase in the velocity across the great vessels. Serum calcium levels were within normal limits. An abdominal ultrasound showed no evidence of calcification or stenosis of renal arteries or the splanchnic circulation. Baby was closely monitored on the neonatal unit and was discharged on day 21 of life with a good weight gain and follow up with the cardiologists. Conclusion Calcification of the great vessels is an uncommon finding in TTTS and is thought to be secondary to the excessive volume overload in the recipient twin. Antenatal ultrasonography is useful in identifying hyperechogenicity of vessel walls. Serial monitoring during pregnancy and postnatal life is imperative to reduce morbidity and mortality associated with this syndrome.