Prenatal progressive cardiomegaly and functional pulmonary atresia on one fetus of monochorionic diamniotic twin pregnancy regardless of spontaneous resolution of isolated polyhydramnios

摘要

A 32-year-old multiparous woman presented to our hospital for perinatal management of monochorionic diamniotic (MD) twin pregnancy at 26 weeks of gestation. The first transabdominal ultrasonography demonstrated that maximum vertical pocket (MVP) was 10.7 cm (twin A)/2.3 cm (twin B) and cardiothoracic area ratio (CTAR) was 37.4%/31.7%. Obvious tricuspid regurgitation (TR) and enlarged bladder were detected in twin A. No major structural anomaly and abnormal Doppler waveforms of the umbilical artery were detected in both fetuses. Because this case didn't meet the criteria of TTTS during the observation, fetoscopic laser surgery was not performed. Regardless of spontaneous normalized polyhydramnios at 28 weeks of gestation, severe TR was prolonged and CTAR continued increasing in twin A (Fig. 1). At 35 weeks of gestation, fetal echocardiography showed retrograde blood flow in the ductus arteriosus and extremely decreased forward blood flow through the pulmonary valve, which suggested functional pulmonary atresia (fPA).