Different patterns of left ventricular “rigid body rotation” in 8-year-old twins with anamnestic twin-to-twin transfusion syndrome (from the MAGYAR-Twin Study)
Letter to the Editor

Different patterns of left ventricular “rigid body rotation” in 8-year-old twins with anamnestic twin-to-twin transfusion syndrome (from the MAGYAR-Twin Study)

Attila Nemes1, Márta Katona2, Péter Domsik1, Anita Kalapos1, Tamás Forster1

1The Second Department of Medicine and Cardiology Centre, 2Department of Pediatrics, Medical Faculty, Albert Szent-Györgyi Clinical Centre, University of Szeged, Szeged, Hungary

Correspondence to: Attila Nemes, MD, PhD, DSc, FESC. 2nd Department of Medicine and Cardiology Centre, Medical Faculty, University of Szeged, Semmelweis Street 6, PO Box 427, H-6725 Szeged, Hungary. Email: nemes.attila@med.u-szeged.hu.

Submitted Aug 08, 2016. Accepted for publication Aug 26, 2016.

doi: 10.21037/qims.2016.11.01


Cardiac dysfunction could be present in twins with anamnestic twin-to-twin transfusion syndrome (TTTS) (1). An 8-year-old monochorionic diamniotic twin pair with anamnestic TTTS was referred for echocardiographic examination. Twins presented prematurity at birth (donor twin: weight, 1,570 g; Apgar: 3-7-9; recipient twin: weight: 2,490 g; Apgar: 8-9-10). They were involved in the ‘Motion Analysis of the heart and Great vessels bY three-dimensionAl speckle-tRacking echocardiography in Twins’ (MAGYAR-Twin) Study. Three-dimensional speckle-tracking echocardiography (3DSTE) was performed using a Toshiba Artida echocardiography equipment with a PST-25SX matrix-array transducer (Toshiba Medical Systems, Tokyo, Japan) (2). Normal left ventricular (LV) dimensions and ejection fraction without wall motion abnormalities were detected. 3DSTE-derived LV radial, circumferential, longitudinal, three-dimensional and area strains proved to be 12.8%±9.3%, −26.0%±9.2%, −18.2%±6.9%, 15.4%±10.8% and −40.2%±11.4%, respectively in donor twin and 22.9%±17.9%, −24.7%±11.9%, −17.4%±8.0%, 24.8%±17.8% and −37.6%±11.5%, respectively in recipient twin. During assessment of LV rotational mechanics, both twins showed absence of LV twist as called LV “rigid body rotation” (RBR). In normal circumstances, due to LV helical myocardial structure a consequent clockwise rotation of the LV base and counterclockwise rotation of the LV apex could be demonstrated (3). In donor twin, both apical (white arrow) and basal (dashed arrow) LV rotations were in the same clockwise direction confirming LV-RBR (Figure 1A). In recipient twin, LV-RBR could also be exhibited but apical and basal LV rotations were in the same counterclockwise direction (Figure 1B). To the best of authors’ knowledges this is the first time to demonstrate different patterns of LV-RBR in twins with anamnestic TTTS.

Figure 1 Different patterns of left ventricular (LV) “rigid body rotation” (RBR) could be demonstrated in an 8-year-old monochorionic diamniotic twin pair with anamnestic twin-to-twin transfusion syndrome. Donor twin (A) showed clockwise-directed apical (white arrow) and basal (dashed arrow) LV rotations confirming LV-RBR, while recipient twin (B) had LV-RBR with apical and basal LV rotations in counterclockwise directions.

Acknowledgements

None.


Footnote

Conflicts of Interest: The authors have no conflicts of interest to declare.


References

  1. Taylor-Clarke MC, Matsui H, Roughton M, Wimalasundera RC, Gardiner HM. Ventricular strain changes in monochorionic twins with and without twin-to-twin transfusion syndrome. Am J Obstet Gynecol 2013;208:462.e1-6. [Crossref] [PubMed]
  2. Nemes A, Kalapos A, Domsik P, Forster T. Three-dimensional speckle-tracking echocardiography -- a further step in non-invasive three-dimensional cardiac imaging. Orv Hetil 2012;153:1570-7. [Crossref] [PubMed]
  3. Nemes A, Kalapos A, Domsik P, Forster T. Left ventricular rotation and twist of the heart. Clarification of some concepts. Orv Hetil 2012;153:1547-51. [Crossref] [PubMed]
Cite this article as: Nemes A, Katona M, Domsik P, Kalapos A, Forster T. Different patterns of left ventricular “rigid body rotation” in 8-year-old twins with anamnestic twin-to-twin transfusion syndrome (from the MAGYAR-Twin Study). Quant Imaging Med Surg 2017;7(1):140-141. doi: 10.21037/qims.2016.11.01

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