Cardiac Manifestations of Twin-to-Twin Transfusion Syndrome.

This review addresses the physiology of monochorionic diamniotic (MC/DA) twins and the potential for twin-twin transfusion syndrome (TTTS). It focuses on the underlying cardiovascular pathophysiology of TTTS and the cardiovascular impact of TTTS for both the recipient and the donor twin. It explains the principles for assessment and monitoring of these cardiovascular changes and how these may be used to guide pregnancy management.

Does the technique of interventional closure of perimembranous ventricular septal defect reduce the incidence of heart block?

Objective: To describe the difficulties and differing techniques in the transcatheter placement of amplatz ventricular septal defect devices to close perimembranous ventricular septal defects and place these in the context of the expanding literature on ventricular septal defect catheter closure.

Background: Surgery remains the established first-line therapy for closure of haemodynamically significant perimembranous ventricular septal defects. Transcatheter techniques appeared to promise a possible alternative, obviating the need for cardiac surgery.

Echocardiographically guided catheter closure of arterial ducts in small preterm infants on the neonatal intensive care unit.

Objective: To describe closure of haemodynamically significant arterial ducts in preterm infants using an echocardiographically guided cardiac catheter technique in selected infants in the neonatal nursery and in preference to cardiac surgery.

Background: Persistently patent arterial ducts are common in preterm infants and are associated with significant morbidity and mortality. Cardiac catheter techniques continue to improve and occlusion of arterial ducts in preterm infants is becoming technically feasible.

Two generations of identical twins with ELN deletion.

We report a family with three generations of an ELN deletion. The grandfather was normal except for two inguinal herniotomies. The first generation identical twins had supravalvular aortic and multiple peripheral pulmonary artery stenoses.

Functional assessment of the evolution of congenital heart disease in utero.

Purpose Of Review: This article reviews recent developments in the assessment of changes in structure and function in the fetal heart with the focus on congenital heart disease malformations.

Recent Findings: Use of the combination of the cardiovascular profile score, the biophysical profile score and additional physiological measurements with Doppler echocardiography have allowed better characterization of disease states and the changes that can occur in utero during the last two trimesters of gestation.

Summary: A comprehensive examination of the structure and function of the fetal heart together with the evaluation of other parameters of fetal wellbeing are necessary for comprehensive assessment of the evolution of congenital heart disease in utero.

A study to determine the incidence of structural congenital heart disease in monochorionic twins.

Objective: To determine the incidence of structural heart disease in at least one of a monochorionic (MC) twin pair excluding any cardiac effects of twin-twin transfusion syndrome (TTTS).

Method: A cohort study of 165 sets of MC twins undergoing detailed fetal echocardiography in a tertiary unit over a 4-year period.

Results: The overall risk of at least one of a MC twin pair having a structural congenital cardiac anomaly was 9.

Catheter closure of the arterial duct in preterm infants.

Background: When medical treatment of a symptomatic arterial duct in a preterm infant fails, management is surgical.

Patients And Methods: 10 preterm neonates referred to a tertiary cardiac centre for treatment of a symptomatic patent arterial duct who underwent cardiac catheterisation with the intention of device closure.

Results: Successful catheter device closure of the arterial duct in nine preterm infants is described.