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Vol. 63. Issue 6.
Pages 551-554 (1 December 2005)
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Vol. 63. Issue 6.
Pages 551-554 (1 December 2005)
Notas clínicas
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Transfusión fetofetal y complicaciones cardiovasculares
Twin-twin transfusion syndrome and cardiovascular complications
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P. Betrián Blasco
Corresponding author
pedrobetrian@yahoo.es

Correspondencia: Dr. P. Betrián Blasco. Fraga, 18, 3.° C. 50003 Zaragoza. España.
, J. Girona Comas, D.C. Albert Brotons
Servicio de Cardiología Pediátrica. Hospital Maternoinfantil Vall d’Hebron. Barcelona. España
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Introducción

El síndrome de transfusión fetofetal presenta una importante morbimortalidad, en parte debida a las alteraciones cardiovasculares que genera.

Casos clínicos

Paciente 1. Se realiza cesárea en la semana 28 por disfunción miocárdica e insuficiencia tricuspídea grave en el feto receptor. A las 12 h de vida, el feto receptor desarrolla un shock refractario. Se objetiva hipertrofia biventricular grave, que acaba en fallecimiento a las 60 h de vida en fallo multiorgánico.

Paciente 2. Se practica cesárea en la semana 29 por cardiomegalia e insuficiencia cardíaca congestiva. Al nacer presenta mala perfusión periférica e hipertensión. Se objetiva hipertrofia biventricular que progresa hasta generar una estenosis medioventricular derecha ligera a las 72 h. Se inicia regresión al octavo día y persiste ligera hipertrofia a los 6 meses.

Discusión

Las alteraciones cardíacas en el síndrome de transfusion fetofetal aparecen sólo en los fetos receptores. Los hallazgos más frecuentes son la existencia de dilatación, hipertrofia, disfunción miocárdica, insuficiencia tricuspídea y estenosis pulmonar. Estas alteraciones suelen regresar con los meses, pudiendo también empeorar.

Palabras clave:
Miocardiopatía
Hipertrofia
Síndrome de transfusion fetofetal
Embarazo gemelar
Introduction

Twin-twin transfusion syndrome carries high morbidity and mortality, related in part to the cardiovascular alterations that it produces.

Case report

Patient 1 underwent a cesarian section at week 28 due to myocardial dysfunction and severe tricuspid regurgitation in the recipient twin. Twelve hours after birth the recipient twin developed refractory shock. Severe biventricular hypertrophy was observed and the twin died 60 hours after birth from multisystemic failure.

Patient 2 underwent a cesarian section at week 29 due to cardiomegaly and cardiac insufficiency in the recipient twin. At birth, he showed hypertension and poor peripheral perfusion. Biventricular hypertrophy was observed, which increased until it produced a mild right midventricular stenosis at 72 hours, decreasing after the 8th day. Mild hypertrophy persisted at 6 months of life.

Discussion

Cardiovascular alterations appear only in recipient fetuses affected by twin-twin transfusion syndrome. The most frequent findings are cardiac dilation, hypertrophy, myocardial dysfunction, tricuspid regurgitation and pulmonary stenosis. These alterations usually disappear during the first few months of life, but may also worsen.

Key words:
Cardiomyopathy
Hypertrophy
Twin-twin transfusion syndrome
Twin pregnancy
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Bibliografía
[1.]
M.JO. Taylor, M.L. Denbow, K.R. Duncan, T.G. Overton, N.M. Fisk.
Antenatal factors at diagnosis that predict outcome in twin-twin transfusion syndrome.
Am J Obstet Gynecol, 183 (2000), pp. 1023-1028
[2.]
G. Mari, A. Roberts, L. Detti, E. Kovanci, T. Stefos, R.O. Bahado-Sing, et al.
Perinatal morbidity and mortalitiy rates in severe twin-twin transfusion syndrome: Results of the International Amnioreduction Registry.
Am J Obstet Gynecol, 185 (2001), pp. 708-715
[3.]
J. Lougheed, B.G. Sinclair, K. Fung Kee Fung, J.L. Bigras, G. Ryan, J.F. Smallhorn, et al.
Acquired right ventricular outflow tract obstruction in the recipient twin in twin-twin transfusion syndrome.
J Am Coll Cardiol, 38 (2001), pp. 1533-1538
[4.]
H.M. Gardiner, M.J.O. Taylor, A. Karatza, T. Vanderheyden, A. Huber, S.E. Greenwald, et al.
Twin-twin transfusion syndrome. The influence of intrauterine laser photocoagulation on arterial distensibility in childhood.
Circulation, 107 (2003), pp. 1906-1911
[5.]
A.A. Karatza, J.L. Wolfenden, M.J.O. Taylor, L. Wee, N.M. Fisk, H.M. Gardiner.
Influence of twin-twin transfusion syndrome on fetal cardiovascular structure and function: prospective casecontrol study of 136 monochorionic twin pregnancies.
Heart, 88 (2002), pp. 271-277
[6.]
D. Mahieu-Caputo, F. Muler, D. Joly, M.C. Gubler, J. Lebidois, L. Fermont, et al.
Pathogenesis of twin-twin transfusion syndrome: the renin-angiotensin system hypothesis.
Fetal Diagn Ther, 16 (2001), pp. 241-244
[7.]
R. Bajoria, S. Ward, R. Chatterjee.
Natriuretic peptides in the pathogenesis of cardiac dysfunction in the recipient fetus of twin-twin transfusion syndrome.
Am J Obstet Gynecol, 186 (2002), pp. 121-127
[8.]
R. Mareschal-Desandes, J.M. Hascoët, G. Bosser, F. Marçon, F. Didier, A. Miton, et al.
Syndrome transfuseur-tranfusé: complications hémodynamiques à propos de deux observations.
Arch Pédiatr, 9 (2002), pp. 377-381
[9.]
Y.C. Seng, V.S. Rajadurai.
Twin-twin transfusion syndrome: A five year review.
Arch Dis Child Fetal Neonatal Ed, 83 (2000), pp. 168-170
[10.]
D. Mahieu-Caputo, L.J. Salomon, J. Le Bidois, L. Fermont, P. Jouvet, Y. Dumez, et al.
Fetal hypertension: An insight into the pathogenesis of the twin-twin transfusion syndrome.
Prenat Diagn, 23 (2003), pp. 640-645
[11.]
L.L. Simpson, G.R. Marx, E.A. Elkadry, M.E. D’Alton.
Cardiac dysfunction in twin-twin transfusion syndrome: a prospective, longitudinal study.
Obstet Gynecol, 92 (1998), pp. 557-562
[12.]
H.M. Hyodo, N. Unno, H. Masuda, T. Watanabe, S. Kozuma, Y. Taketani.
Myocardial hypertrophy of the recipient twins in twin-twin transfusion syndrome and cerebral palsy.
Int J Gynaecol Obstet, 80 (2003), pp. 29-34
[13.]
T. Murakoshi, K. Yamamori, Y. Tojo, H. Naruse, M. Seguchi, Y. Torii, et al.
Pulmonary stenosis in recipient twins in twin-to-twin transfusion syndrome: report on 3 cases and review of the literature.
Croat Med J, 41 (2000), pp. 252-256
[14.]
V. Fesslova, L. Villa, S. Nava, F. Mosca, U. Nicolini.
Fetal and neonatal echocardiographic findings in twin-twin transfusion syndrome.
Am J Obstet Gynecol, 179 (1998), pp. 1056-1062
[15.]
N. Zosmer, R. Bajoria, E. Weiner, M. Rigby, J. Vaughan, N.M. Fisk.
Clinical and echocardiographic features of in utero cardiac dysfunction in the recipient twin in twin-twin transfusion syndrome.
Br Heart J, 72 (1994), pp. 74-79
[16.]
A. Saxena, N.R. Soni.
Pulmonary artery calcification in recipient twins of twin to twin transfusion sydrome: A report a three cases.
Pediatr Cardiol, 24 (2003), pp. 80-83
Copyright © 2005. Asociación Española de Pediatría
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