Prenatal progressive cardiomegaly and functional pulmonary atresia on one fetus of monochorionic diamniotic twin pregnancy regardless of spontaneous resolution of isolated polyhydramnios.
Prenatal progressive cardiomegaly and functional pulmonary atresia on one fetus of monochorionic diamniotic twin pregnancy regardless of spontaneous resolution of isolated polyhydramnios.
复制标题
单绒毛膜双羊膜双胎妊娠的一名胎儿产前进行性心脏肥大和功能性肺动脉闭锁，无论孤立性羊水过多的自发消退如何。
DOI：
10.1016/j.tjog.2018.11.009
复制
发表时间：
2019
期刊：
影响因子：
--
通讯作者：
Yoshida Y
中科院分区：
文献类型：
--
作者：
Kawamura H1;Nishijima K;Fujii K;Tamura S;Takahashi J;Yoshida Y
一位32岁的多胎妇女在妊娠26周时因单绒毛膜双羊膜（MD）双胎妊娠来到我院接受围产期治疗。首次经腹超声检查显示，最大垂直口袋（MVP）为10.7 cm（双A）/2.3 cm（双B），心胸面积比（CTAR）为37.4%/31.7%。双胎a均未见明显的三尖瓣反流（TR）和膀胱肿大，两胎脐动脉未见重大结构异常和多普勒波形异常。由于该病例在观察时不符合TTTS标准，故未行胎儿镜激光手术。无论妊娠28周自发性羊水过多，双胞胎A的严重TR延长，CTAR继续增加（图1）。妊娠35周，胎儿超声心动图显示动脉导管血流逆行，通过肺动脉瓣的血流急剧减少，提示功能性肺闭锁（fPA）。妊娠37周再次行剖宫产术。双胞胎A和B的出生体重分别为2902 g/2591 g。双胞胎A出生时的超声心动图显示严重的TR和轻微的前向血流通过肺动脉瓣。出生后约3小时发生去饱和，并输注前列腺素E1 (PGE1)，诊断为fPA。出生后第2天暂停PGE1输注。在此之后，他在9个月时存活，除了中度TR外，没有其他主要并发症。
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). Repeat cesarean section was conducted at 37 weeks of gestation. Both were male and birth weight of twin A and B were 2902 g/2591 g, respectively. Echocardiography of twin A at birth demonstrated severe TR and slight forward blood flow through the pulmonary valve. Desaturation occurred in about 3 h after birth and prostaglandin E1 (PGE1) was infused, based on the diagnosis of fPA. PGE1 infusion was suspended on postnatal day 2. After that, he was alive without major complications other than moderate TR at the age of nine months.