How commonly can we see esophageal atresia in both dizygotic twins?

There is an over representation of twins in the esophageal atresia (EA) population. 1 However, for both of the twins to have the condition is extremely rare, especially if dizygotic. 1 – 6 This paper describes a pair of spontaneous dizygotic twins, both affected with EA with tracheo-esophageal fistula (TEF). A 27-year-old healthy Caucasian woman, G1P0, naturally conceived dichorionic diamniotic twins, both with EA with TEF (Gross type C). She was working as a radiology technician and the pregnancy was screened from 29 weeks of gestation. There was no prenatal diagnosis. Spontaneous vaginal delivery occurred at 35 weeks and the diagnosis was made at birth in both twins. The babies were dizygotic as confirmed by having different blood types (type O in twin 1 and type A in twin 2). There were no associated malformations. Twin 2 needed nasal prong oxygen therapy and had surgery on the second day of life; twin 1 had surgery on the third day of life. Single-stage primary repair by thoracotomy was success-ful in both, they were extubated within 72 hours and the post-operative period was uneventful. Both babies were discharged within 1 month and at 2-month follow-up they remain asymptomatic. Genetic consultation was requested. is