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A narrative synthesis of cardiac adaptation patterns was performed. Additionally, a meta\u2010analysis compared the livebirth prevalence of CHD in TTTS and sFGR against uncomplicated MC twins.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In TTTS recipients, cardiac function may be impaired for diastolic, systolic, as well as global functions, while in donors, cardiac function is generally preserved. In sFGR, large twins may show hypertrophic cardiomyopathy, and small twins may show impaired systolic function. Co\u2010occurrence of TTTS and sFGR magnifies cardiac impact but is often underreported. Meta\u2010analysis for CHD prevalence revealed a relative risk ratio of 3.5 (95% CI: 2.5\u20134.9) for TTTS and 2.2 (95%CI: 1.3\u20133.5) for sFGR compared with uncomplicated MC twins.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study highlights the well\u2010documented cardiac adaptation in TTTS, contrasting with limited understanding in sFGR. Elevated CHD risks were observed in both conditions. Enhanced cardiovascular surveillance is warranted in complicated MC twin pregnancies. Future research should explore cardiac adaptation in sFGR and its long\u2010term consequences.<\/jats:p><\/jats:sec>","DOI":"10.1002\/pd.6575","type":"journal-article","created":{"date-parts":[[2024,4,21]],"date-time":"2024-04-21T12:57:52Z","timestamp":1713704272000},"page":"832-845","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Cardiac adaptation and malformation in twin\u2013twin transfusion syndrome and selective fetal growth restriction: A systematic review"],"prefix":"10.1002","volume":"44","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7666-4127","authenticated-orcid":false,"given":"Anne T. 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