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Hypertrophic cardiomyopathy‐like changes in monochorionic twin pregnancies with selective intrauterine growth restriction and intermittent absent/reversed end‐diastolic flow in the umbilical artery
Author(s) -
MuñozAbellana B.,
HernandezAndrade E.,
FigueroaDiesel H.,
Ferrer Q.,
AcostaRojas R.,
Cabero L.,
Gratacos E.
Publication year - 2007
Publication title -
ultrasound in obstetrics and gynecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 3.202
H-Index - 141
eISSN - 1469-0705
pISSN - 0960-7692
DOI - 10.1002/uog.5166
Subject(s) - medicine , intrauterine growth restriction , fetus , ventricle , monochorionic twins , umbilical artery , cardiology , in utero , hypertrophic cardiomyopathy , obstetrics , diastole , pregnancy , blood pressure , genetics , biology
Objective To evaluate the prevalence of hypertrophic cardiomyopathy‐like (HCL) changes in monochorionic twins with selective intrauterine growth restriction (sIUGR) and intermittent absent/reversed end‐diastolic flow (iAREDF), also defined as Type III sIUGR, and the clinical relevance of this condition. Methods A total of 80 pregnancies with sIUGR were studied, 40 with, and 40 without iAREDF. HCL changes were defined as an increased thickness of either left or right ventricular wall (mean > 2 SD) estimated with M‐mode ultrasonography. Data were plotted on normal reference values constructed from 75 uncomplicated monochorionic twin pregnancies (150 fetuses) at 22–34 weeks' gestation. Perinatal outcomes in pregnancies with and without HCL changes were compared. Results In the group with iAREDF, 8/40 of the larger twins (20%) had HCL changes (five bilaterally, two in the right, and one in the left ventricle) as compared with 1/40 (2.5%) in fetuses without iAREDF ( P = 0.03). No differences were observed in the smaller twin (1/40 in both groups). HCL changes were not associated with a significant increment in perinatal mortality as only one large fetus from the group with iAREDF died in utero. In the remaining 10 cases, no differences in the intertwin weight discordance, placental surface discordance, or rate of neonatal neurological damage were observed. However, all 10 presented mildly abnormal neonatal cardiac findings that resolved over time with no apparent short‐term impact on cardiac function. Conclusions HCL changes in the larger twin should be regarded as part of the spectrum of findings in Type III monochorionic‐sIUGR (presenting iAREDF). This finding does not seem to be associated with an increased rate of short‐term neurological or cardiac complications. Copyright © 2007 ISUOG. Published by John Wiley & Sons, Ltd.