case_images: PMC11810567_01
case_images: Ultrasonography of Patient 1. (A) Shows an increased cardiothoracic ratio of 0.66. (B) Shows the hyperechoic placenta in twin A and the thickened and hypoechoic placenta in twin B. (C) Shows a starry sky liver. (D,E) Show abnormal middle cerebral artery peak systolic velocities (MCA-PSVs) in both twins. F1 shows twin A, and F2 shows twin B.
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case_images: fig1
case_images: TAPS (Figure 1). After discussion between the multidisciplinary medical team and the family and the completion of antenatal glucocorticoid treatment, a cesarean section was performed.
case_images: PMC11810567_02
case_images: MCA-PSVs on ultrasonography of the fetuses of Patient 2 before and after laser surgery. (A,B) Show MCA-PSVs of the twins before laser surgery, and (C,D) show MCA-PSVs of the twins after surgery.
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case_images: fig2
case_images: Twin B was the donor, with an MCA-PSV of 2.05 MoM (Figures 2A,B), an enlarged heart, a cardiothoracic ratio of 0.55, a thickened placenta of 46.8 mm, and enhanced placental echogenicity; the amniotic fluid volume was 72 mm in the donor sac and 62 mm in the recipient sac; the weight difference between the twins was 30.8%, which also indicated complicated selective intrauterine growth restriction (sIUGR). A-V anastomoses, and amniotic fluid was reduced by 400 mL during the operation. An ultrasound performed 24 h following the procedure revealed a significant decrease in the MCA-PSV of the donor twin (Figures 2C,D).
case_images: Placenta and umbilical vessels of Patient 2 after air infusion. The placental areas and diameters of the umbilical cords of twins A and B are shown. The vessels were separated from each other between the junctional parts of the placenta when air was sequentially infused into the umbilical arteries. Traces of laser cautery of blood vessels were clearly observed (yellow arrows). The battledore placenta of twin B.
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case_images: fig3
case_images: The vessels (arteries of one twin and veins of the other) were separated from each other at the junction when air was sequentially infused into the two pairs of umbilical arteries (Figure 3).