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Review

Congenital Heart Defects in Monochorionic Twins: A Systematic Review and Meta-Analysis

by
Manon Gijtenbeek
1,*,
Maryam R. Shirzada
1,
Arend D. J. Ten Harkel
2,
Dick Oepkes
1 and
Monique C. Haak
1
1
Division of Fetal Medicine, Department of Obstetrics, Leiden University Medical Center, PO Box 9600, NL-2300 RC Leiden, The Netherlands
2
Division of Pediatric Cardiology, Department of Pediatrics, Leiden University Medical Center, PO Box 9600, NL-2300 RC Leiden, The Netherlands
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2019, 8(6), 902; https://doi.org/10.3390/jcm8060902
Submission received: 20 May 2019 / Revised: 14 June 2019 / Accepted: 18 June 2019 / Published: 24 June 2019
(This article belongs to the Special Issue Diagnosis, Treatment and Outcome in Complicated Monochorionic Twins)
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Abstract

Monochorionic (MC) twins are at an increased risk of developing congenital heart defects (CHDs) compared to singletons and dichorionic twins. The development of acquired CHDs in this specific group of twins is associated with twin–twin transfusion syndrome (TTTS). We performed a systematic review and meta-analysis to provide an overview of the reported birth prevalence of CHDs in liveborn MC twins with and without TTTS. Twelve studies were included in this review. Compared to the reference population, MC twins were 6.3 times more likely to be born with a CHD (59.3 per 1000 liveborn twins; relative risk (RR) 6.3; 95% confidence interval (CI): 4.4–9.1), and TTTS twins had a 12-fold increased risk of having a CHD at birth (87.3 per 1000 live births; RR 12.4, 95% CI: 8.6–17.8). The increased incidence of CHDs can mainly be attributed to the risk of right ventricular outflow tract obstruction (35/1000 TTTS twin live births vs. 0.5/1000 singleton live births). We recommend an expert fetal echocardiogram in all MC twins, follow-up scans in the event of TTTS, and a postnatal cardiac evaluation in all TTTS survivors.
Keywords: congenital heart defect; monochorionic twin pregnancy; prevalence; twin–twin transfusion syndrome; newborn congenital heart defect; monochorionic twin pregnancy; prevalence; twin–twin transfusion syndrome; newborn

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MDPI and ACS Style

Gijtenbeek, M.; Shirzada, M.R.; Ten Harkel, A.D.J.; Oepkes, D.; C. Haak, M. Congenital Heart Defects in Monochorionic Twins: A Systematic Review and Meta-Analysis. J. Clin. Med. 2019, 8, 902. https://doi.org/10.3390/jcm8060902

AMA Style

Gijtenbeek M, Shirzada MR, Ten Harkel ADJ, Oepkes D, C. Haak M. Congenital Heart Defects in Monochorionic Twins: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine. 2019; 8(6):902. https://doi.org/10.3390/jcm8060902

Chicago/Turabian Style

Gijtenbeek, Manon, Maryam R. Shirzada, Arend D. J. Ten Harkel, Dick Oepkes, and Monique C. Haak. 2019. "Congenital Heart Defects in Monochorionic Twins: A Systematic Review and Meta-Analysis" Journal of Clinical Medicine 8, no. 6: 902. https://doi.org/10.3390/jcm8060902

APA Style

Gijtenbeek, M., Shirzada, M. R., Ten Harkel, A. D. J., Oepkes, D., & C. Haak, M. (2019). Congenital Heart Defects in Monochorionic Twins: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine, 8(6), 902. https://doi.org/10.3390/jcm8060902

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