Cardiovascular changes secondary to imbalanced transfusion have been described in twin-to-twin transfusion syndrome (TTTS) [8] and selective fetal growth restriction (sFGR) [9] using Doppler analysis [10,11], echocardiographic parameters [12,13], and cardiac dysfunction biomarkers, such as fetal B-type natriuretic peptide (BNP) [14,15]. Here, NPPB is linked to twin to twin transfusion syndrome.