Hidaka Nobuhiro, Tsukimori Kiyomi, Chiba Yoshihide, Hara Toshiro, Wake Norio
Department of Obstetrics and Gynecology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan.
J Perinat Med. 2007;35(5):425-30. doi: 10.1515/JPM.2007.099.
To review the course of monochorionic (MC) twin gestations in which one or both fetuses were diagnosed with congenital heart disease (CHD) and to identify clinical characteristics regarding the related intrauterine environmental factors particularly associated with non-twin-twin transfusion syndrome (TTTS).
This study is a review of a two-center experience of MC twin pregnancies with CHD born between 2000 and 2006.
There were 87 MC twin pregnancies of which 11 were associated with fetal heart disease. We found concordance of CHD in 2 of the 11 twin sets. Among all of the discordant cases, the size of the affected twin was smaller. TTTS was observed in one case associated with CHD; in this case the donor twin had a coarctation of the aorta. Abnormal cord insertion was observed in 9 (69%) out of the 13 affected infants, and a significant relation was found between the presence of CHD and abnormal cord insertion.
Of the MC twins, the smaller seemed more likely to be affected by primary structural cardiac anomalies. CHD in MC twins is possibly related to an abnormal cord insertion. Further studies are warranted to determine whether a causal relationship exists.
回顾单绒毛膜（MC）双胎妊娠中一个或两个胎儿被诊断患有先天性心脏病（CHD）的病程，并确定与相关宫内环境因素有关的临床特征，尤其是与双胎输血综合征（TTTS）无关的因素。
本研究回顾了2000年至2006年间在两个中心出生的患有CHD的MC双胎妊娠的经验。
共有87例MC双胎妊娠，其中11例与胎儿心脏病有关。我们发现11对双胎中有2对CHD一致。在所有不一致的病例中，受影响的双胎较小。在1例与CHD相关的病例中观察到TTTS；在该病例中，供血双胎患有主动脉缩窄。13例受影响婴儿中有9例（69%）观察到脐带插入异常，并且发现CHD的存在与脐带插入异常之间存在显著关系。
在MC双胎中，较小的双胎似乎更容易受到原发性心脏结构异常的影响。MC双胎中的CHD可能与脐带插入异常有关。有必要进行进一步研究以确定是否存在因果关系。
