Childhood cardiac function after twin-to-twin transfusion syndrome - a 10-year follow up

Aim: To perform a 10-year follow up of cardiac structure and function after twin-to-twin transfusion syndrome (TTTS) - a severe foetal circulatory complication associated with myocardial hypertrophy in the recipient twin. Methods: Cardiac dimensions, systolic and diastolic function as assessed by echocardiography including flow and tissue Doppler velocimetry in 22 healthy survivors of TTTS with a mean age of 9.6 (7.2-11.8) years. Results: The donor and recipient twin did not show any differences in end-diastolic ventricular size, interventricular septum thickness, diameter of right ventricular outflow tract, cardiac valves, coronary arteries or in systolic blood flow velocities. However, compared with the donors, the recipients had significantly lower E/A ratios because of lower E-waves in both mitral (-0.15 +/- 0.10, p < 0.01) and tricuspid (-0.09 +/- 0.07, p < 0.01) valves, indicating reduced early diastolic ventricular fillings compared with donors. Conclusion: At school age, twins surviving TTTS had a cardiac structure and function within normal range. There were no differences in heart structure or systolic ventricular function between twins but, compared with the donor twin, we found a reduced early diastolic function in the recipient.