{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,16]],"date-time":"2026-02-16T03:10:26Z","timestamp":1771211426378,"version":"3.50.1"},"reference-count":33,"publisher":"Wiley","issue":"6","license":[{"start":{"date-parts":[[2017,5,2]],"date-time":"2017-05-02T00:00:00Z","timestamp":1493683200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp; Gyne"],"published-print":{"date-parts":[[2017,6]]},"abstract":"ABSTRACT<\/jats:title>Objectives<\/jats:title>Severe right ventricular outflow tract obstruction (RVOTO<\/jats:styled-content>) is a potential complication in recipient twins of twin\u2010to\u2010twin transfusion syndrome (TTTS<\/jats:styled-content>) that requires postnatal follow\u2010up or treatment. We aimed to evaluate pregnancy characteristics of neonates with RVOTO<\/jats:styled-content> from complicated monochorionic twin pregnancies, determine the incidence of RVOTO<\/jats:styled-content> in TTTS<\/jats:styled-content> cases and construct a prediction model for its development.<\/jats:p><\/jats:sec>Methods<\/jats:title>This was an observational cohort study of all complicated monochorionic twin pregnancies with a postnatal diagnosis of RVOTO<\/jats:styled-content> examined at our center. Cases were referred for evaluation of the need for fetal therapy or intervention because of TTTS<\/jats:styled-content>, selective intrauterine growth restriction (sIUGR<\/jats:styled-content>) or multiple congenital malformations in one of the twins. Ultrasound data were retrieved from our monochorionic twin database. Among liveborn TTTS<\/jats:styled-content> recipients treated prenatally with laser therapy, those with RVOTO<\/jats:styled-content> were compared with those without RVOTO<\/jats:styled-content> (controls). We describe four additional cases with RVOTO<\/jats:styled-content> that were not TTTS<\/jats:styled-content> recipients.<\/jats:p><\/jats:sec>Results<\/jats:title>A total of 485 twin pregnancies received laser therapy for TTTS<\/jats:styled-content> during the study period. RVOTO<\/jats:styled-content> was diagnosed in 3% (11\/368) of liveborn TTTS<\/jats:styled-content> recipients, of whom two showed mild Ebstein's anomaly. Before laser therapy, pericardial effusion was seen in 45% (5\/11) of RVOTO<\/jats:styled-content> cases (P<\/jats:italic>\u2009<\u20090.01) and abnormal A\u2010wave in the ductus venosus (DV<\/jats:styled-content>) in 73% (8\/11) (P<\/jats:italic>\u2009=\u20090.03), significantly higher proportions than in controls. Mean gestational age at laser therapy was 17\u2009+\u20093\u2009weeks in RVOTO<\/jats:styled-content> cases compared with 20\u2009+\u20093\u2009weeks in controls (P<\/jats:italic>\u2009=\u20090.03). A prediction model for RVOTO<\/jats:styled-content> was constructed incorporating these three significant variables. One TTTS<\/jats:styled-content> donor had RVOTO<\/jats:styled-content> after the development of transient hydrops following laser therapy. Three larger twins in pregnancies complicated by sIUGR<\/jats:styled-content> developed RVOTO<\/jats:styled-content>, the onset of which was detectable early in the second trimester.<\/jats:p><\/jats:sec>Conclusions<\/jats:title>RVOTO<\/jats:styled-content> occurs in TTTS<\/jats:styled-content> recipient twins but can also develop in TTTS<\/jats:styled-content> donors and larger twins of pregnancies complicated by sIUGR<\/jats:styled-content>. Abnormal flow in the DV<\/jats:styled-content>, pericardial effusion and early gestational age at onset of TTTS<\/jats:styled-content> are predictors of RVOTO<\/jats:styled-content> in TTTS<\/jats:styled-content> recipients, which suggests increased vulnerability to hemodynamic imbalances in the fetal heart in early pregnancy. These findings could guide diagnostic follow\u2010up protocols after TTTS<\/jats:styled-content> treatment. Copyright \u00a9 2016 ISUOG. Published by John Wiley & Sons Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.16008","type":"journal-article","created":{"date-parts":[[2016,7,1]],"date-time":"2016-07-01T12:13:15Z","timestamp":1467375195000},"page":"737-743","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":39,"title":["Right ventricular outflow tract obstruction in complicated monochorionic twin pregnancy"],"prefix":"10.1002","volume":"49","author":[{"given":"S. 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