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It originates from unbalanced transfer of fluid and vasoactive mediators from one twin to its co\u2010twin via placental anastomoses. This results in hypovolemia in the donor and hypervolemia and vasoconstriction in the recipient twin. Consequently, the recipient demonstrates cardiovascular alterations including atrioventricular valve regurgitation, diastolic dysfunction, and pulmonary stenosis\/atresia that do not necessarily correlate with Quintero\u2010stages. Selective fetoscopic laser photocoagulation of placental vascular anastomoses disrupts the underlying pathophysiology and usually improves cardiovascular function in the recipient with normalization of systolic and diastolic function within weeks after treatment. Postnatal studies have demonstrated early decreased arterial distensibility in ex\u2010donor twins, but 10\u2010year follow up is encouraging with survivors showing normal cardiovascular function after <jats:styled-content style=\"fixed-case\">TTTS<\/jats:styled-content>. However, prediction and appropriate early management of <jats:styled-content style=\"fixed-case\">TTTS<\/jats:styled-content> remain poor. Assessment of the cardiovascular system provides additional insight into the pathophysiology and severity of <jats:styled-content style=\"fixed-case\">TTTS<\/jats:styled-content> and may permit more targeted early surveillance of <jats:styled-content style=\"fixed-case\">MCDA<\/jats:styled-content> pregnancies in future. It should form an integral part of the diagnostic algorithm.<\/jats:p>","DOI":"10.1111\/aogs.12871","type":"journal-article","created":{"date-parts":[[2016,2,12]],"date-time":"2016-02-12T15:40:17Z","timestamp":1455291617000},"page":"664-671","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":43,"title":["Fetal cardiovascular hemodynamics in twin\u2013twin transfusion syndrome"],"prefix":"10.1111","volume":"95","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3184-0980","authenticated-orcid":false,"given":"Christoph","family":"Wohlmuth","sequence":"first","affiliation":[{"name":"The Fetal Center UT Health School of Medicine Houston TX USA"},{"name":"Department of Obstetrics and Gynecology Paracelsus Medical University Salzburg Austria"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9436-4897","authenticated-orcid":false,"given":"Helena 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