Uncomplicated Monochorionic Twins: Two Normal Hearts Sharing One Placenta
Cardiovascular dysfunction has been reported in complicated monochorionic diamniotic (MCDA) pregnancies; however, little is known whether hemodynamic changes occur in uncomplicated MCDA twins. A prospective observational study was conducted including 100 uncomplicated MCDA twins matched by gestation...
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doaj-1d6fc187ef1d465b8885418031d67f862020-11-25T04:05:27ZengMDPI AGJournal of Clinical Medicine2077-03832020-11-0193602360210.3390/jcm9113602Uncomplicated Monochorionic Twins: Two Normal Hearts Sharing One PlacentaXimena Torres0Mar Bennasar1Laura García-Otero2Raigam J. Martínez-Portilla3Brenda Valenzuela-Alcaraz4Fátima Crispi5Anna Goncé6Eduard Gratacós7Francesc Figueras8Josep M. Martínez9Fetal Medicine Research Center, BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), 08028 Barcelona, SpainFetal Medicine Research Center, BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), 08028 Barcelona, SpainFetal Medicine Research Center, BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), 08028 Barcelona, SpainFetal Medicine Research Center, BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), 08028 Barcelona, SpainFetal Medicine Research Center, BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), 08028 Barcelona, SpainFetal Medicine Research Center, BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), 08028 Barcelona, SpainFetal Medicine Research Center, BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), 08028 Barcelona, SpainFetal Medicine Research Center, BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), 08028 Barcelona, SpainFetal Medicine Research Center, BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), 08028 Barcelona, SpainFetal Medicine Research Center, BCNatal-Barcelona Center for Maternal-Fetal and Neonatal Medicine (Hospital Clínic and Hospital Sant Joan de Deu), 08028 Barcelona, SpainCardiovascular dysfunction has been reported in complicated monochorionic diamniotic (MCDA) pregnancies; however, little is known whether hemodynamic changes occur in uncomplicated MCDA twins. A prospective observational study was conducted including 100 uncomplicated MCDA twins matched by gestational age to 200 low-risk singletons. Echocardiography was performed at 26–30 weeks gestation and cord blood B-type natriuretic peptide (BNP) was measured at delivery. In both groups, z-scores for echocardiographic parameters were within normal ranges; however the monochorionic group had larger atrial areas (mean (standard deviation) right atria-to-heart ratio: 17.0 (2) vs. 15.9 (1); <i>p</i> = 0.018; left atria-to-heart ratio: 17.0 (3) vs. 15.8 (2); <i>p</i> < 0.001) and signs of concentric hypertrophy (right relative wall thickness: 0.66 (0.12) vs. 0.56 (0.11); <i>p</i> < 0.001; left relative wall thickness: 0.69 (0.14) vs. 0.58 (0.12); <i>p</i> < 0.001). Longitudinal function was increased in twins, leading to higher tricuspid annular plane systolic excursion (6.9 mm (0.9) vs. 5.9 mm (0.7); <i>p</i> < 0.001) and mitral annular plane systolic excursion (4.9 mm (0.8) vs. 4.4 mm (1.1); <i>p</i> < 0.001. BNP levels at birth were also higher in MCDA twins (median [interquartile range]: 20.81 pg/mL [16.69–34.01] vs. 13.14 pg/mL [9.17–19.84]; <i>p</i> < 0.001). Thus, uncomplicated MCDA fetuses have normal cardiac shape and function, but signs of cardiac adaptation were identified by echocardiographic and biochemical parameters, when compared with singletons.https://www.mdpi.com/2077-0383/9/11/3602uncomplicated monochorionic twinsfetal echocardiographycardiac adaptationcardiac functioncardiac shapeB-type natriuretic peptide |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Ximena Torres Mar Bennasar Laura García-Otero Raigam J. Martínez-Portilla Brenda Valenzuela-Alcaraz Fátima Crispi Anna Goncé Eduard Gratacós Francesc Figueras Josep M. Martínez |
spellingShingle |
Ximena Torres Mar Bennasar Laura García-Otero Raigam J. Martínez-Portilla Brenda Valenzuela-Alcaraz Fátima Crispi Anna Goncé Eduard Gratacós Francesc Figueras Josep M. Martínez Uncomplicated Monochorionic Twins: Two Normal Hearts Sharing One Placenta Journal of Clinical Medicine uncomplicated monochorionic twins fetal echocardiography cardiac adaptation cardiac function cardiac shape B-type natriuretic peptide |
author_facet |
Ximena Torres Mar Bennasar Laura García-Otero Raigam J. Martínez-Portilla Brenda Valenzuela-Alcaraz Fátima Crispi Anna Goncé Eduard Gratacós Francesc Figueras Josep M. Martínez |
author_sort |
Ximena Torres |
title |
Uncomplicated Monochorionic Twins: Two Normal Hearts Sharing One Placenta |
title_short |
Uncomplicated Monochorionic Twins: Two Normal Hearts Sharing One Placenta |
title_full |
Uncomplicated Monochorionic Twins: Two Normal Hearts Sharing One Placenta |
title_fullStr |
Uncomplicated Monochorionic Twins: Two Normal Hearts Sharing One Placenta |
title_full_unstemmed |
Uncomplicated Monochorionic Twins: Two Normal Hearts Sharing One Placenta |
title_sort |
uncomplicated monochorionic twins: two normal hearts sharing one placenta |
publisher |
MDPI AG |
series |
Journal of Clinical Medicine |
issn |
2077-0383 |
publishDate |
2020-11-01 |
description |
Cardiovascular dysfunction has been reported in complicated monochorionic diamniotic (MCDA) pregnancies; however, little is known whether hemodynamic changes occur in uncomplicated MCDA twins. A prospective observational study was conducted including 100 uncomplicated MCDA twins matched by gestational age to 200 low-risk singletons. Echocardiography was performed at 26–30 weeks gestation and cord blood B-type natriuretic peptide (BNP) was measured at delivery. In both groups, z-scores for echocardiographic parameters were within normal ranges; however the monochorionic group had larger atrial areas (mean (standard deviation) right atria-to-heart ratio: 17.0 (2) vs. 15.9 (1); <i>p</i> = 0.018; left atria-to-heart ratio: 17.0 (3) vs. 15.8 (2); <i>p</i> < 0.001) and signs of concentric hypertrophy (right relative wall thickness: 0.66 (0.12) vs. 0.56 (0.11); <i>p</i> < 0.001; left relative wall thickness: 0.69 (0.14) vs. 0.58 (0.12); <i>p</i> < 0.001). Longitudinal function was increased in twins, leading to higher tricuspid annular plane systolic excursion (6.9 mm (0.9) vs. 5.9 mm (0.7); <i>p</i> < 0.001) and mitral annular plane systolic excursion (4.9 mm (0.8) vs. 4.4 mm (1.1); <i>p</i> < 0.001. BNP levels at birth were also higher in MCDA twins (median [interquartile range]: 20.81 pg/mL [16.69–34.01] vs. 13.14 pg/mL [9.17–19.84]; <i>p</i> < 0.001). Thus, uncomplicated MCDA fetuses have normal cardiac shape and function, but signs of cardiac adaptation were identified by echocardiographic and biochemical parameters, when compared with singletons. |
topic |
uncomplicated monochorionic twins fetal echocardiography cardiac adaptation cardiac function cardiac shape B-type natriuretic peptide |
url |
https://www.mdpi.com/2077-0383/9/11/3602 |
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