{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T02:20:42Z","timestamp":1760149242307,"version":"build-2065373602"},"reference-count":21,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2023,7,17]],"date-time":"2023-07-17T00:00:00Z","timestamp":1689552000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Right ventricular outflow tract anomalies (RVOTAs), such as pulmonary stenosis (PS), pulmonary atresia (PA), and pulmonary insufficiency (PI), are typical cardiac anomalies in monochorionic twins, and they are complicated by twin-to-twin transfusion syndrome (TTTS). The aim of this study was to conduct a long-term postnatal cardiological evaluation of prenatal RVOTAs in monochorionic diamniotic twin pregnancies complicated by TTTS and treated with fetoscopic laser surgery (FLS) and to analyze possible prenatal predictors of congenital heart disease (CHD). Prenatal RVOTAs were retrospectively retrieved from all TTTS cases treated with FLS in our unit between 2009 and 2019. Twenty-eight prenatal cases of RVOTAs (16 PI, 10 PS, 2 PA) were observed out of 335 cases of TTTS. Four cases did not reach the postnatal period. CHD was present in 17 of the remaining 24 cases (70.8%), with 10 being severe (58.8%; 10\/17); nine cases of PS required balloon valvuloplasty, and one case required biventricular non-compaction cardiomyopathy. The risk of major CHD increased with prenatal evidence of PS and decreased with the gestational age at the time of TTTS and with the prenatal normalization of blood flow across the pulmonary valve. Despite treatment with FLS, the majority of monochorionic diamniotic twin pregnancies complicated by TTTS with prenatal RVOTAs had CHD at long-term follow-up.<\/jats:p>","DOI":"10.3390\/jcm12144734","type":"journal-article","created":{"date-parts":[[2023,7,18]],"date-time":"2023-07-18T01:46:02Z","timestamp":1689644762000},"page":"4734","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Long-Term Postnatal Follow-Up in Monochorionic TTTS Twin Pregnancies Treated with Fetoscopic Laser Surgery and Complicated by Right Ventricular Outflow Tract Anomalies"],"prefix":"10.3390","volume":"12","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-5537-7145","authenticated-orcid":false,"given":"Stefano","family":"Faiola","sequence":"first","affiliation":[{"name":"Fetal Therapy Unit \u2018Umberto Nicolini\u2019, Buzzi Children\u2019s Hospital, 20154 Milan, Italy"},{"name":"Department of Woman, Mother and Neonate, Buzzi Children\u2019s Hospital, 20154 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Maria","family":"Mandalari","sequence":"additional","affiliation":[{"name":"Department of Woman, Mother and Neonate, Buzzi Children\u2019s Hospital, 20154 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Chiara","family":"Coco","sequence":"additional","affiliation":[{"name":"Department of Woman, Mother and Neonate, Buzzi Children\u2019s Hospital, 20154 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8856-442X","authenticated-orcid":false,"given":"Daniela","family":"Casati","sequence":"additional","affiliation":[{"name":"Fetal Therapy Unit \u2018Umberto Nicolini\u2019, Buzzi Children\u2019s Hospital, 20154 Milan, Italy"},{"name":"Department of Woman, Mother and Neonate, Buzzi Children\u2019s Hospital, 20154 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Arianna","family":"Laoreti","sequence":"additional","affiliation":[{"name":"Fetal Therapy Unit \u2018Umberto Nicolini\u2019, Buzzi Children\u2019s Hospital, 20154 Milan, Italy"},{"name":"Department of Woman, Mother and Neonate, Buzzi Children\u2019s Hospital, 20154 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Savina","family":"Mannarino","sequence":"additional","affiliation":[{"name":"Pediatric Cardiology Unit, Buzzi Children\u2019s Hospital, 20154 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carla","family":"Corti","sequence":"additional","affiliation":[{"name":"Pediatric Cardiology Unit, Buzzi Children\u2019s Hospital, 20154 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8935-3843","authenticated-orcid":false,"given":"Dario","family":"Consonni","sequence":"additional","affiliation":[{"name":"Epidemiology Unit, Fondazione IRCCS Ca\u2019 Granda, Ospedale Maggiore Policlinico, 20122 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9217-3034","authenticated-orcid":false,"given":"Irene","family":"Cetin","sequence":"additional","affiliation":[{"name":"Department of Woman, Mother and Neonate, Buzzi Children\u2019s Hospital, 20154 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0765-1298","authenticated-orcid":false,"given":"Mariano","family":"Lanna","sequence":"additional","affiliation":[{"name":"Fetal Therapy Unit \u2018Umberto Nicolini\u2019, Buzzi Children\u2019s Hospital, 20154 Milan, Italy"},{"name":"Department of Woman, Mother and Neonate, Buzzi Children\u2019s Hospital, 20154 Milan, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2023,7,17]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1533","DOI":"10.1016\/S0735-1097(01)01549-2","article-title":"Acquired right ventricular outflow tract obstruction in the recipient twin in twin-twin transfusion syndrome","volume":"38","author":"Lougheed","year":"2001","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1136\/heart.88.3.271","article-title":"Influence of twin-twin transfusion syndrome on fetal cardiovascular structure and function: Prospective case-control study of 136 monochorionic twin pregnancies","volume":"88","author":"Karatza","year":"2002","journal-title":"Heart"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"379","DOI":"10.1016\/j.placenta.2009.02.005","article-title":"The basic and clinical science of twin\u2013twin transfusion syndrome","volume":"30","author":"Fisk","year":"2009","journal-title":"Placenta"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"716","DOI":"10.1053\/plac.2001.0715","article-title":"Atrial natriuretic peptide mediated polyuria: Pathogenesis of polyhydramnios in the recipient twin of twin-twin transfusion syndrome","volume":"22","author":"Bajoria","year":"2001","journal-title":"Placenta"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"136","DOI":"10.1056\/NEJMoa032597","article-title":"Endoscopic laser surgery versus serial amnioreduction for severe twin-to-twin transfusion syndrome","volume":"351","author":"Senat","year":"2004","journal-title":"N. Engl. J. Med."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1002\/uog.7748","article-title":"Effect of selective fetoscopic laser photocoagulation therapy for twin-twin transfusion syndrome on pulmonary valve pathology in recipient twins","volume":"37","author":"Rand","year":"2011","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1013","DOI":"10.1002\/pd.5378","article-title":"Acquired Right Ventricular Outflow Tract Obstruction in twin-to-twin transfusion syndrome; a prospective longitudinal study","volume":"38","author":"Eschbach","year":"2018","journal-title":"Prenat. Diagn."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1038\/sj.jp.7200292","article-title":"Staging of twin-twin transfusion syndrome","volume":"19","author":"Quintero","year":"1999","journal-title":"J. Perinatol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"209","DOI":"10.1111\/chd.12215","article-title":"Prevalence, Spectrum, and Outcome of Right Ventricular Outflow Tract Abnormalities in Twin-twin Transfusion Syndrome: A Large, Single-center Experience","volume":"10","author":"Michelfelder","year":"2015","journal-title":"Congenit. Heart Dis."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"2144","DOI":"10.1016\/S0140-6736(13)62419-8","article-title":"Fetoscopic laser coagulation of the vascular equator versus selective coagulation for twin-to-twin transfusion syndrome: An open-label randomised controlled trial","volume":"383","author":"Slaghekke","year":"2014","journal-title":"Lancet"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1360","DOI":"10.1111\/echo.13527","article-title":"Echocardiographic assessment of pediatric semilunar valve disease","volume":"34","author":"Cantinotti","year":"2017","journal-title":"Echocardiography"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/ejechocard\/jen303","article-title":"Echocardiographic assessment of valve stenosis: EAE\/ASE recommendations for clinical practice","volume":"10","author":"Baumgartner","year":"2009","journal-title":"Eur. J. Echocardiogr."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"400.e1","DOI":"10.1016\/j.ajog.2009.01.051","article-title":"Assessment of fetal cardiac function before and after therapy for twin-to-twin transfusion syndrome","volume":"200","author":"Klaritsch","year":"2009","journal-title":"Am. J. Obstet. Gynecol."},{"key":"ref_14","doi-asserted-by":"crossref","unstructured":"Chang, Y.L., Chao, A.S., Chang, S.D., Cheng, P.J., Li, W.F., and Hsu, C.C. (2022). Incidence, prognosis, and perinatal outcomes of and risk factors for severe twin-twin transfusion syndrome with right ventricular outflow tract obstruction in the recipient twin after fetoscopic laser photocoagulation. BMC Pregnancy Childbirth, 22.","DOI":"10.1186\/s12884-022-04668-1"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1510","DOI":"10.1002\/pd.6052","article-title":"Right ventricular outflow tract abnormalities in monochorionic twin pregnancies without twin-to-twin transfusion syndrome: Prenatal course and postnatal long-term outcomes","volume":"41","author":"Faiola","year":"2021","journal-title":"Prenat. Diagn."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"504","DOI":"10.1002\/uog.26098","article-title":"Congenital heart defects in monochorionic twin pregnancy complicated by selective fetal growth restriction","volume":"61","author":"Faiola","year":"2023","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"737","DOI":"10.1002\/uog.16008","article-title":"Right ventricular outflow tract obstruction in complicated monochorionic twin pregnancy","volume":"49","author":"Eschbach","year":"2017","journal-title":"Ultrasound Obstet. Gynecol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"190","DOI":"10.36129\/jog.2022.48","article-title":"Birth prevalence of right ventricular outflow tract abnormalities in the recipient twin of monochorionic twin pregnancies complicated by twin-to-twin transfusionsyndrome: Amnioreduction versus fetoscopic laser coagulation treatment","volume":"35","author":"Faiola","year":"2023","journal-title":"Ital. J. Gyn\u00e6cology Obstet."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1981","DOI":"10.1016\/j.jacc.2014.08.034","article-title":"Left ventricular noncompaction: A genetic cardiomyopathy looking for diagnostic criteria","volume":"64","year":"2014","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"966","DOI":"10.1056\/NEJM199903253401215","article-title":"Isolated noncompaction of the myocardium","volume":"340","author":"Jenni","year":"1999","journal-title":"N. Engl. J. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1161\/CIRCGEN.121.003517","article-title":"Genetic Basis of Left Ventricular Noncompaction","volume":"15","author":"Rojanasopondist","year":"2022","journal-title":"Circ. Genom. Precis. Med."}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/14\/4734\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T20:13:35Z","timestamp":1760127215000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/12\/14\/4734"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,7,17]]},"references-count":21,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2023,7]]}},"alternative-id":["jcm12144734"],"URL":"https:\/\/doi.org\/10.3390\/jcm12144734","relation":{},"ISSN":["2077-0383"],"issn-type":[{"type":"electronic","value":"2077-0383"}],"subject":[],"published":{"date-parts":[[2023,7,17]]}}}