Case presentation
A 27-year-old pregnant woman, primigravida, MC twin pregnancy, with a gestational age of 21 weeks was referred to our center due to stage 3 TTTS. Her pregnancy was a product of in vitro fertilization (IVF). She had no significant past medical history and she did not use any drugs. Fetal echocardiography showed severe coarctation of aorta (CoA) in the descending aorta with retrograde flow in the donor twin (Figure 1). No other major anomalies were detected in the fetuses. FLP was performed at our center for treating TTTS. Accordingly, further development of TTTS was stopped and at 33 weeks of gestation, the pregnancy was terminated by cesarean section due to the onset of labor pains. Both babies were born with good APGAR score and appropriate weight. Postnatal echocardiography of donor twin in the supra-sternal view showed severe narrowing of proximal part of aorta with flow acceleration (Figure 2). In Doppler assessment, we detected a typical saw tooth appearance in the location of coarctation (Figure 3) and apical four chamber view showed left ventricular hypertrophy (LVH), significant left ventricular enlargement (LVE) and left atrial enlargement (LAE) (Figure 4). With a diagnosis of persistent aortic coarctation (figure 5), donor twin underwent balloon inflation of aorta in the stenotic portion at the age of one month. Balloon inflation of aorta in the stenotic location caused the narrowing to completely resolve (Figure 6, 7, 8) and transthoracic echocardiography after balloon angioplasty in suprasternal view showed significant reduction in aortic stenosis (Figure 9).