Discussion
CoA is a common congenital heart defect that is characterized by a
narrowing distal to the aortic arch and the prenatal diagnosis is
challenging and difficult.(9) Its coincidence with TTTS is rare and
there have been only a few cases in the literature. (6) Assessment of
ventricular size is helpful in prenatal diagnosis and the left ventricle
is usually smaller than the right ventricle. Also, comparison of the
width of the aorta, ductus arteriosus and coarctation shelf in color
doppler studies may suggest that the defect will require an intervention
after birth (10). TTTS is associated with an increased prevalence of
congenital heart diseases (CHDs). In MC pregnancies with TTTS, the risk
of at least one of the infants with CHD is threefold compared to
uncomplicated MC twin pregnancies (11). The development of acquired CHDs
in MC twins is associated with TTTS, indicating an influence of
hemodynamic alterations on cardiac development. MC twins with TTTS are
associated with increased risk of ventricular septal defect (VSD),
RVOTO, atrial septal defect (ASD), CoA, and aortic stenosis (AS). Some
of them are uncommon, such as CoA and AS (8). There are reports of a
small number of CoA in recipient and donor twins in TTTS. After birth,
due to ductal closure, a variety of hemodynamic changes may occur
according to the severity of obstruction and critical coarctation
increases the risk of heart failure and death in infants when the ductus
arteriosus closes. So, prenatal diagnosis is important to reduce
postnatal complications. After birth, prostaglandins type 1 is necessary
to avoid closure of ductus arteriosus and definite treatment is
end-to-end anastomosis, but transcatheter treatment is also an accepted
alternative with comparable results (9). Balloon angioplasty is an
acceptable technique, similar to what was done in our case. It is a safe
procedure in infants between one and six months of age and also in
critically ill patients regardless of age (12). The best time for CoA
correction is in infancy or childhood in order to prevent persistence or
late recurrence of systemic hypertension (13).