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- W2000412203 abstract "Twin-reverse arterial perfusion (TRAP) is a rare anomaly affecting 1% of monochorionic twin pregnancies. Retrograde perfusion from the normal (pump) twin results in an increased hemodynamic burden that may negatively affect cardiac output and cardiovascular (CV) status. The objective of this study was to determine the relationship between CO in the pump twin and other measures of CV status. Fetal echocardiographic studies of TRAP twins referred from January 1997- August 2007 were reviewed. Qualitative and quantitative fetal CV data were collected. Combined CO of right and left ventricle was calculated using Doppler interrogation across the aortic and pulmonary valves, measurement of valve diameter, and heart rate. A total of 49 cases of TRAP pregnancies were identified; mean gestational age 20 + 2.4 weeks. CO ranged from 411- 1095, median = 518 ml/kg/min and 30 pump twins had CO >500 ml/kg/min (abnormally elevated). CO correlated significantly with increased cardiothoracic ratio, ventricular hypertrophy, and early diastolic inflow velocities across the mitral (p<0.01), but not the tricuspid valve. Tricuspid regurgitation tended to be more likely in those with higher CO (p=0.18). No correlation was seen between umbilical or middle cerebral artery pulsatility indices and CO. No hydrops fetalis was identified. The presence of polyhydramnios (n=15) or pericardial effusion (n=2) was not associated with increased CO. Despite an increase hemodynamic burden in the pump twin, most fetuses are able to compensate for an increase CO resulting in no evidence of heart failure or hydrops. CV evaluation can be used to monitor for worsening status. Long-term postnatal follow-up is warranted to determine the impact of increase cardiac output on the developing fetus." @default.
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- W2000412203 date "2009-12-01" @default.
- W2000412203 modified "2023-09-26" @default.
- W2000412203 title "280: Impact of cardiac output on cardiovascular manifestations in twin reverse arterial perfusion sequence" @default.
- W2000412203 doi "https://doi.org/10.1016/j.ajog.2009.10.295" @default.
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