Fetal Cardiac MRI using Doppler Ultrasound for evaluation of thoracoomphalopagus conjoined twins (QF_TH_051)

Thursday, January 30, 2025

4:40 PM – 4:50 PM East Coast USA Time

Location: Blue Room PreFunction

Presenting Author(s)

AF

Andrea I. Fuentealba Cargill, MD

Cardiac Fetal Imaging Fellow
Children's Hospital Colorado

Primary Author(s)

AF

Andrea I. Fuentealba Cargill, MD

Cardiac Fetal Imaging Fellow
Children's Hospital Colorado

Co-Author(s)

Richard M. Friesen, MD

Assistant Professor
Children's Hospital Colorado
TF

Takashi Fujiwara, PhD

Postdoctoral fellow
University of Colorado Anschutz Medical Campus, Children's Hospital Colorado
SP

Sungho Park, PhD

Postdoctoral Fellow
Children's Hospital Colorado, University of Colorado Anschutz Medical Campus
EE

Erin Englund, PhD

Assistant Research Professor
University of Colorado Anschutz Medical Campus
AB

Alex J. Barker, PhD

Associate Professor
Children's Hospital Colorado, University of Colorado Anschutz Medical Campus
GA

Gladys Arguello Fletes, MD

Pediatric Neuroradiology Fellow
Children's Hospital Colorado
NB

Nicholas Behrendt, MD

Associate Professor
Children's Hospital Colorado
CL

Camila L. Londono Obregon, MD

Associate Professor
University of Colorado
Lorna P. Browne, MD

Professor
University of Colorado and Children's Hospital Colorado

Description of Clinical Presentation: A 29-year-old female (G6P4) was referred to our center following identification of thoracoomphalopagus conjoined twins, with fused heart and liver, at 20 weeks of gestation. Fetal echocardiogram and fetal cardiac MRI (cMRI) were performed at 21 weeks gestation to evaluate for potential post-natal repair.

Diagnostic Techniques and Their Most Important Findings: Fetal cMRI was performed @ 1.5 T using an MRI compatible fetal doppler ultrasound (DUS) device (smart-sync, Northh imaging) for cardiac gating. Protocol included multiplanar cine SSFP sequences and multiplanar blackblood sequences.
Fetal echocardiography and cMRI were used together to understand the complex anatomical arrangements. Each twin had 2 sets of atria (with an interatrial connection) but only a single ventricle. Twin A had a left ventricle, pulmonary atresia and major aortopulmonary collateral arteries. Twin B had a right ventricle, coarctation of the aorta, bilateral superior vena cava and partial anomalous pulmonary venous return. After counselling regarding the grave prognosis of both twins, the patient decided to deliver at her local hospital with comfort care.

Learning Points from this Case: This case of conjoined twins at 21 weeks gestation, is the youngest example of successful clinical DUS fetal cMRI. In this case, fetal CMR was used to demonstrate the great vessel anatomy and was fundamental in ascertaining the absence of a path to successful surgical palliation for either twin. Additionally, fetal CMR was used as the primary modality during patient counselling to explain the anomalies. The high degree of diagnostic certainty that the fetal CMR facilitated, allowed the family to avoid the unnecessary emotional and financial expense that relocation for delivery would have incurred and facilitated palliative care at their local center.