{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,6]],"date-time":"2026-04-06T08:48:26Z","timestamp":1775465306549,"version":"3.50.1"},"reference-count":27,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2024,3,14]],"date-time":"2024-03-14T00:00:00Z","timestamp":1710374400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2024,8]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>We aimed to investigate the incidence, prenatal factors and outcomes of twin\u2010to\u2010twin transfusion (TTTS) with right ventricular outflow tract obstruction (RVOTO).<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and methods<\/jats:title><jats:p>A systematic search was conducted to identify relevant studies published until February 2023 in English using the databases PubMed, Scopus and Web of Science. Studies reporting on pregnancies with TTTS and RVOTO were included. The random\u2010effect model pooled the mean differences or odds ratios (OR) and the corresponding 95% confidence intervals. Heterogeneity was assessed using the <jats:italic>I<\/jats:italic><jats:sup><jats:italic>2<\/jats:italic><\/jats:sup> value.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>A total of 17 studies encompassing 4332 TTTS pregnancies, of which 225 cases had RVOTO, were included. Incidence of RVOTO at time of TTTS diagnosis was 6%. In all, 134\/197 (68%) had functional pulmonary stenosis and 62\/197 (32%) had functional pulmonary atresia. Of these, 27% resolved following laser and 55% persisted after birth. Of those persisting, 27% required cardiac valve procedures. Prenatal associations were TTTS stage III (53% vs 39% in no\u2010RVOTO), stage IV TTTS (28% in RVOTO vs 12% in no\u2010RVOTO) and ductus venosus reversed a\u2010wave (60% in RVOTO vs 19% in no\u2010RVOTO). Gestational age at laser and gestational age at delivery were comparable between groups. Survival outcomes were also comparable between groups, including fetal demise of 26%, neonatal death of 12% and 6\u2010month survival of 82% in RVOTO group. Findings were similar when subgroup analysis was done for studies including head\u2010to\u2010head analysis.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>RVOT occurs in about 6% of the recipient twins with TTTS, especially in stages III and IV and those with reversed ductus venosus a\u2010wave. The findings from this systematic review support the need for a thorough cardiac assessment of pregnancies complicated by TTTS, both before and after laser, to maximize perinatal outcome, and the importance of early diagnosis of TTTS and timely management.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.14825","type":"journal-article","created":{"date-parts":[[2024,3,14]],"date-time":"2024-03-14T11:28:56Z","timestamp":1710415736000},"page":"1513-1521","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Right ventricular outflow tract obstruction in twin\u2010to\u2010twin transfusion syndrome undergoing laser surgery: A systematic review and meta\u2010analysis"],"prefix":"10.1111","volume":"103","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5611-1231","authenticated-orcid":false,"given":"Hiba J.","family":"Mustafa","sequence":"first","affiliation":[{"name":"Division of Maternal\u2010Fetal Medicine Indiana University School of Medicine  Indianapolis Indiana USA"},{"name":"The Fetal Center at Riley Children's and Indiana University Health  Indianapolis Indiana USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Muhammad","family":"Jawwad","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery Dow University of Health and Sciences  Karachi Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ayesha","family":"Iqbal\u00a0Mansoor","sequence":"additional","affiliation":[{"name":"Department of Medicine and Surgery Dow University of Health and Sciences  Karachi Pakistan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5934-9758","authenticated-orcid":false,"given":"Giorgio","family":"Pagani","sequence":"additional","affiliation":[{"name":"Maternal Fetal Medicine Unit, Department of Obstetrics and Gynecology, ASST\u2010Papa Giovanni XXIII  Bergamo 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