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A recipient twin with twin-twin transfusion syndrome (TTTS) exhibited 6~15% mitral regurgitation (MR), and hence, a poor prognosis. Fetoscopic laser photo (FLP) coagulation was performed on the recipient twin who presented with cardiomegaly and hydrops fetalis, after which severe mitral and tricuspid regurgitation and cardiomegaly failed to resolve. Here, we present the case of a recipient twin with TTTS. The mother, at 19 weeks and 4 days of gestation, was referred for fetal hydrops. Ultrasonography indicated severe MR. FLP was performed at 19 weeks and 5 days, after which the hydrops fetalis resolved gradually. At 27 weeks, we noted cardiomegaly and severe MR in the recipient. The patient was delivered by an emergency caesarian section, which had to be performed because of premature rupture of the membranes at 32 weeks and 4 days. Postnatal cardiac ultrasonography indicated severe mitral regurgitation, with the anterior leaflet of the mitral valve prolapsed and thickened. Despite the presence of pulmonary hemorrhage at the age of 1 day, the patient was treated with indomethacin to close the ductus arteriosus, thereby improving MR and the respiratory state, while resolving pulmonary hypertension. We concluded that the cause of MR was volume overload in the left atrium and mild abnormalities in the mitral valve. MR did not worsen later during infancy.

nihon shoni junkanki gakkai zasshi/nihon shōni junkanki gakkai zasshi

The Case of a Recipient Twin Suffering from Twin-twin Transfusion Syndrome Whose Mitral Regurgitation Did Not Improve after Fetoscopic Laser Photocoagulation