Abstract
Background: We recently presented several 3D/4DUS-based fetal cardiac functional measures: end-diastolic and end-systolic ventricular volume and myocardial mass, ejection fraction (obtained by 3DUS), contraction fraction (CF), and 4D-MPI in uncomplicated cases. Management decisions in MCBA twins are traditionally based on degrees of poly/oligohydramnios and Quintero staging, as well as fetal 2DUS-Doppler based measures, myocardial performance index (MPI), or mid-cerebral artery measures. We now applied the above 3D/4DUS-based measures to the evaluation and management of MCBA twins. Methods: During a 12 month period, 15 MCBA twin pregnancies were followed in our center with both classic U/S parameters and 3D/4DUS cardiac functional parameters. During bi-weekly (or more as indicated) examinations, Quintero staging and other 2DUS Doppler parameters including umbilical artery, MCA, and aorta Doppler, shunt determination, and others were evaluated, and in addition 3D/4D based measures: cardiac volumes and mass, EF, CF, and 4D-MPI. Results: 15 MCBA twins were followed. Group I: 6 cases with TTTS (Quintero stage 2–3, 4 of whom eventually required laser ablation); Group II: 4 cases that developed selective IUGR; and 5 MCBA pregnancies progressed normally. In Group II we observed intermittent absent or reversed diastolic flow in the UA, but no other pathologies were noted in 2D or 3D/4D examination. In all Group I cases we observed that in the recipient and the donor, 3D/4D measures: ventricular mass, IVS, EF and 4D-MPI were consistently outside normal range (1–2 SD). Appearance of cardiac functional pathology preceded the appearance of Quintero stage parameters. Following laser ablation, cardiac functional parameters, except for ventricular mass, returned to normal within 96 hours, preceding normalization of Quintero parameters. Conclusions: 3D/4DUS cardiac function surveillance may add to the armamentarium of the evaluation and management of MCBA pregnancies, may be more sensitive to developing or resolving pathology.
Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
