{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T22:59:15Z","timestamp":1781650755205,"version":"3.54.5"},"reference-count":21,"publisher":"Springer Science and Business Media LLC","license":[{"start":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T00:00:00Z","timestamp":1776988800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"},{"start":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T00:00:00Z","timestamp":1776988800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["Pediatr Cardiol"],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Monochorionic monoamniotic (MCMA) twin pregnancies are typically delivered at 32\u201334 weeks of gestation to reduce the risk of intrauterine demise, but this practice may compromise outcomes for a growth-restricted or very\u2013low-birth-weight twin requiring complex cardiac surgery. We conducted a literature review in Cochrane Central Register of Controlled Trials, EMBASE and PubMed from inception to October 26, 2025. We included reports of MCMA twin pregnancies with one fetus with TGA describing perinatal outcomes, cord complications, and cardiac surgery in very\u2013low-birth-weight neonates. Of 388 records identified, 302 abstracts were screened, 54 full texts reviewed, and 8 studies were included. Only five published cases of MCMA with one twin affected by transposition of the great arteries were identified: two in conjoined twins, one with postmortem diagnosis after extreme prematurity, and two operated cases, of whom just one survived. We describe to our knowledge the third non-conjoined MCMA twin pregnancy with TGA and only the second postoperative survivor, delivered at 34 weeks. Systematic reviews have suggested that, in otherwise stable MCMA pregnancies with TGA, prolonging gestation to at least 33 weeks is considered safe, and based on our experience we suggest that prolonging pregnancy to 34 weeks may still be beneficial, but multicenter data is needed to reach this conclusion.<\/jats:p>","DOI":"10.1007\/s00246-026-04271-7","type":"journal-article","created":{"date-parts":[[2026,4,24]],"date-time":"2026-04-24T09:50:38Z","timestamp":1777024238000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Perinatal Management and Appropriate Time of Delivery in Monochorionic Monoamniotic Twins When One Twin has Transposition of the Great Arteries. A Case Report and Systematic Review of the Literature"],"prefix":"10.1007","author":[{"given":"Juanita","family":"Montoya","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura","family":"Tapasco","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leonardo","family":"Mulinari","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodrigo","family":"Ruano","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jaime","family":"Alkon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,4,24]]},"reference":[{"key":"4271_CR1","doi-asserted-by":"publisher","DOI":"10.3390\/jcm8060902","volume":"8","author":"M Gijtenbeek","year":"2019","unstructured":"Gijtenbeek M, Shirzada MR, Ten Harkel ADJ et al (2019) Congenital heart defects in monochorionic twins: a systematic review and meta-analysis. J Clin Med 8:902","journal-title":"J Clin Med"},{"key":"4271_CR2","doi-asserted-by":"publisher","first-page":"2183","DOI":"10.1161\/01.cir.0000437597.44550.5d","volume":"129","author":"MT Donofrio","year":"2014","unstructured":"Donofrio MT, Moon-Grady AJ, Hornberger LK et al (2014) Diagnosis and treatment of fetal cardiac disease: a scientific statement from the American Heart Association. Circulation 129:2183\u20132242","journal-title":"Circulation"},{"key":"4271_CR3","doi-asserted-by":"publisher","first-page":"1491","DOI":"10.7863\/jum.2007.26.11.1491","volume":"26","author":"MO Bahtiyar","year":"2007","unstructured":"Bahtiyar MO, Dulay AT, Weeks BP et al (2007) Prevalence of congenital heart defects in monochorionic\/diamniotic twin gestations: a systematic literature review. J Ultrasound Med 26:1491\u20131498","journal-title":"J Ultrasound Med"},{"key":"4271_CR4","doi-asserted-by":"publisher","first-page":"52","DOI":"10.2350\/06-05-0060.1","volume":"9","author":"S Steggerda","year":"2006","unstructured":"Steggerda S, Lopriore E, Sueters M et al (2006) Twin-to-twin transfusion syndrome, vein of galen malformation, and transposition of the great arteries in a pair of monochorionic twins: coincidence or related association? Pediatr Dev Pathol 9:52\u201355","journal-title":"Pediatr Dev Pathol"},{"key":"4271_CR5","doi-asserted-by":"publisher","DOI":"10.1093\/ejcts\/ezac552","author":"S Henmi","year":"2022","unstructured":"Henmi S, Essa Y, \u00d6zt\u00fcrk M et al (2022) Cardiovascular surgery in very low birth weight (\u2264\u20091500 g) neonates. Eur J Cardiothorac Surg. https:\/\/doi.org\/10.1093\/ejcts\/ezac552","journal-title":"Eur J Cardiothorac Surg"},{"key":"4271_CR6","doi-asserted-by":"publisher","first-page":"488","DOI":"10.1053\/j.semtcvs.2018.03.007","volume":"31","author":"M Salna","year":"2019","unstructured":"Salna M, Chai PJ, Kalfa D et al (2019) Outcomes of the arterial switch operation in \u2264\u20092.5-kg neonates. Semin Thorac Cardiovasc Surg 31:488\u2013493","journal-title":"Semin Thorac Cardiovasc Surg"},{"key":"4271_CR7","doi-asserted-by":"publisher","first-page":"840","DOI":"10.1016\/j.athoracsur.2016.11.079","volume":"103","author":"TA Fricke","year":"2017","unstructured":"Fricke TA, Bulstra AE, Loyer BR et al (2017) Outcomes of the arterial switch operation in children less than 2.5 kilograms. Ann Thorac Surg 103:840\u2013844","journal-title":"Ann Thorac Surg"},{"key":"4271_CR8","doi-asserted-by":"publisher","first-page":"70","DOI":"10.1111\/j.1741-4520.2005.00068.x","volume":"45","author":"I \u00dcst\u00fcner","year":"2005","unstructured":"\u00dcst\u00fcner I, \u015eim\u015fek E, Kahraman K, Cengiz B, Ko\u00e7 A (2005) Acardiac acephalic twin gestation with transposition of great arteries in pump twin. Congenit Anom 45:70\u201372. https:\/\/doi.org\/10.1111\/j.1741-4520.2005.00068.x","journal-title":"Congenit Anom"},{"key":"4271_CR9","doi-asserted-by":"publisher","first-page":"371","DOI":"10.1007\/s12519-012-0385-x","volume":"8","author":"G Chen","year":"2012","unstructured":"Chen G, Jia B, Zhang W-B (2012) Successful surgical repair of d-transposition of the great arteries in a separated conjoined twin. World J Pediatr 8:371\u2013373","journal-title":"World J Pediatr"},{"key":"4271_CR10","doi-asserted-by":"publisher","DOI":"10.1016\/j.athoracsur.2020.02.039","volume":"110","author":"M Haranal","year":"2020","unstructured":"Haranal M, Leong MC, Muniandy SR et al (2020) Ductal stenting to permit delayed arterial switch operation in a separated conjoined twin. Ann Thorac Surg 110:e327\u2013e329","journal-title":"Ann Thorac Surg"},{"key":"4271_CR11","doi-asserted-by":"publisher","first-page":"201","DOI":"10.1002\/uog.7501","volume":"35","author":"T Dias","year":"2010","unstructured":"Dias T, Mahsud-Dornan S, Bhide A et al (2010) Cord entanglement and perinatal outcome in monoamniotic twin pregnancies. Ultrasound Obstet Gynecol 35:201\u2013204","journal-title":"Ultrasound Obstet Gynecol"},{"key":"4271_CR12","doi-asserted-by":"publisher","first-page":"1064","DOI":"10.1016\/j.jtcvs.2007.06.009","volume":"134","author":"Y Kaneko","year":"2007","unstructured":"Kaneko Y, Tsuchiya K, Yamamoto Y et al (2007) Arterial switch in a 1146-gram neonate with transposition of the great arteries and an intramural coronary artery. J Thorac Cardiovasc Surg 134:1064\u20131065","journal-title":"J Thorac Cardiovasc Surg"},{"key":"4271_CR13","doi-asserted-by":"publisher","first-page":"601","DOI":"10.21037\/tp-21-569","volume":"11","author":"Q Hu","year":"2022","unstructured":"Hu Q, Deng C, Zhu Q et al (2022) Dextro-transposition of the great arteries in one twin: case reports and literature review. Transl Pediatr 11:601\u2013609","journal-title":"Transl Pediatr"},{"key":"4271_CR14","doi-asserted-by":"publisher","DOI":"10.1515\/crpm-2020-0022","author":"M Pasieczna","year":"2020","unstructured":"Pasieczna M, Kuran-Ohde J, Kajdy A et al (2020) Monoamniotic twins pregnancy complicated by a fetal congenital heart defect \u2013 a challenge for perinatal decisions. Case Rep Perinat Med. https:\/\/doi.org\/10.1515\/crpm-2020-0022","journal-title":"Case Rep Perinat Med"},{"key":"4271_CR15","doi-asserted-by":"publisher","first-page":"166","DOI":"10.1002\/uog.20100","volume":"53","author":"F D\u2019Antonio","year":"2019","unstructured":"D\u2019Antonio F, Odibo A, Berghella V et al (2019) Perinatal mortality, timing of delivery and prenatal management of monoamniotic twin pregnancy: systematic review and meta-analysis. Ultrasound Obstet Gynecol 53:166\u2013174","journal-title":"Ultrasound Obstet Gynecol"},{"key":"4271_CR16","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1002\/uog.20203","volume":"53","author":"T Van Mieghem","year":"2019","unstructured":"Van Mieghem T, Shub A (2019) Management of monoamniotic twins: the question is not \u201cwhere?\u201d, but \u201chow? Ultrasound Obstet Gynecol 53:151\u2013152","journal-title":"Ultrasound Obstet Gynecol"},{"key":"4271_CR17","doi-asserted-by":"publisher","first-page":"131","DOI":"10.1002\/uog.12345","volume":"41","author":"AC Rossi","year":"2013","unstructured":"Rossi AC, Prefumo F (2013) Impact of cord entanglement on perinatal outcome of monoamniotic twins: a systematic review of the literature: Monoamniotic twins and cord entanglement. Ultrasound Obstet Gynecol 41:131\u2013135","journal-title":"Ultrasound Obstet Gynecol"},{"key":"4271_CR18","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0194814","volume":"13","author":"LE Linde","year":"2018","unstructured":"Linde LE, Rasmussen S, Kessler J, Ebbing C (2018) Extreme umbilical cord lengths, cord knot and entanglement: risk factors and risk of adverse outcomes, a population-based study. PLoS One 13:e0194814","journal-title":"PLoS One"},{"key":"4271_CR19","doi-asserted-by":"publisher","first-page":"173","DOI":"10.1016\/j.athoracsur.2006.07.042","volume":"83","author":"R Roussin","year":"2007","unstructured":"Roussin R, Belli E, Bruniaux J et al (2007) Surgery for transposition of the great arteries in neonates weighing less than 2,000 grams: a consecutive series of 25 patients. Ann Thorac Surg 83:173\u2013177 discussion 177-8","journal-title":"Ann Thorac Surg"},{"key":"4271_CR20","doi-asserted-by":"publisher","first-page":"1250","DOI":"10.1067\/mob.2000.104923","volume":"182","author":"SJ Min","year":"2000","unstructured":"Min SJ, Luke B, Gillespie B et al (2000) Birth weight references for twins. Am J Obstet Gynecol 182:1250\u20131257","journal-title":"Am J Obstet Gynecol"},{"key":"4271_CR21","first-page":"931","volume":"108","author":"VM Allen","year":"2001","unstructured":"Allen VM, Windrim R, Barrett J, Ohlsson A (2001) Management of monoamniotic twin pregnancies: a case series and systematic review of the literature. BJOG 108:931\u2013936","journal-title":"BJOG"}],"container-title":["Pediatric Cardiology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00246-026-04271-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/article\/10.1007\/s00246-026-04271-7","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/link.springer.com\/content\/pdf\/10.1007\/s00246-026-04271-7.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,6,16]],"date-time":"2026-06-16T22:39:53Z","timestamp":1781649593000},"score":1,"resource":{"primary":{"URL":"https:\/\/link.springer.com\/10.1007\/s00246-026-04271-7"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,4,24]]},"references-count":21,"alternative-id":["4271"],"URL":"https:\/\/doi.org\/10.1007\/s00246-026-04271-7","relation":{},"ISSN":["0172-0643","1432-1971"],"issn-type":[{"value":"0172-0643","type":"print"},{"value":"1432-1971","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,4,24]]},"assertion":[{"value":"18 January 2026","order":1,"name":"received","label":"Received","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"15 April 2026","order":2,"name":"accepted","label":"Accepted","group":{"name":"ArticleHistory","label":"Article History"}},{"value":"24 April 2026","order":3,"name":"first_online","label":"First Online","group":{"name":"ArticleHistory","label":"Article History"}},{"order":1,"name":"Ethics","group":{"name":"EthicsHeading","label":"Declarations"}},{"value":"The authors declare no competing interests.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing Interests"}},{"value":"Ethical approval statement is not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical Approval"}},{"value":"Written and verbal informed consent was obtained from the patient by the senior author for publication of this case report and the accompanying images.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Informed Consent"}}]}}