Twin congenital heart disease in the setting of twin-to-twin transfusion syndrome

Twin 1 (birth weight (BW) 1835 g, gestation 33+4) of monochorionic, diamniotic twins (MCDA) presented with a 4/6 murmur on postnatal examination. The pregnancy was affected by mild twin-twin transfusion syndrome (TTTS). The echocardiogram in Twin 1 (recipient) revealed severe pulmonary stenosis (gradient 134 mm Hg, figure 1). The infant underwent balloon valvuloplasty on day 14 of life. In week 3 of life, Twin 2 (BW 1300 g) was noted to have a murmur. An echocardiogram showed coarctation of the aorta (CoA) (descending aorta 2.5 mm at narrowest point, figure 2). Surgical intervention was not indicated. Both twins had normal routine cardiac views antenatally.