scholarly journals Twin reversed arterial perfusion sequence: the heartless twin

2020 ◽  
Vol 9 (5) ◽  
pp. 2201
Author(s):  
Ashwin Rao ◽  
Rashmi Rao
Keyword(s):  
Cardiac Failure ◽  
Vascular Malformations ◽  
Therapeutic Interventions ◽  
Laser Coagulation ◽  
Arterial Perfusion ◽  
Acardiac Twin ◽  
Normal Foetus ◽  
Twin Reversed Arterial Perfusion ◽  
Normal Twin ◽  
Pump Twin

To report a case of twin reversal arterial perfusion sequence and its management by means of laser coagulation of the vascular malformation in the placenta. Twin reversed arterial perfusion sequence is a rare form of twin to twin transfusion syndrome occurring primarily in Monochorionic monoamniotic twins. The prevalence is about 1 in 35,000 pregnancies. The significance of this condition is that there is a normal foetus and an acardiac foetus. The blood is shunted from the normal twin to the acardiac twin through vascular malformations in the placenta. The normal twin faces a high risk of both morbidity and mortality due to cardiac failure. A case of twin reversal arterial perfusion sequence diagnosed at 22 weeks following a target scan underwent laser photocoagulation and gave birth vaginally at 30 weeks without any complications. Early detection of this condition can lead to timely intervention and thereby improve the outcome. In Twin reversal arterial perfusion sequence, the normal or the pump twin has a high chance of mortality due to cardiac failure. As the size of the acardiac twin increases, there is a higher chance of mortality of the pump twin. There is a need for regular follow up with ultrasonography and foetal echocardiography along with early therapeutic interventions to ensure the survival of the normal twin. In our case, despite the large size of the acardiac twin, we had a successful pregnancy outcome for the normal twin due to timely intervention.

scholarly journals A Case of Trap Sequence with Immense Acardiac Twin

Folia Medica ◽  
2014 ◽  
Vol 56 (2) ◽  
pp. 129-132
Author(s):  
Georgi I. Amaliev ◽  
Maria L. Malinova ◽  
Blagovest K. Pehlivanov ◽  
Hristina A. Ivancheva
Keyword(s):  
Twin Pregnancy ◽  
Rare Complication ◽  
Arterial Perfusion ◽  
Acardiac Twin ◽  
Trap Sequence ◽  
Complicated Pregnancy ◽  
Twin Reversed Arterial Perfusion ◽  
Normal Twin ◽  
Pump Twin

Abstract Twin-reversed arterial perfusion sequence is a rare complication of monochorionic twin pregnancy in which an anomalous acardiac fetus is hemodynamically dependent on its structurally normal “pump” twin. Early diagnosis is essential for improving perinatal prognosis for the normal twin. In this case report we present a case of TRAP sequence with immense acardiac twin with favorable outcome, emphasizing the importance of ultrasound imaging, follow-up and timing of delivery in this complicated pregnancy.

scholarly journals Conservative management of a case of a cardiac anceps twin reversed arterial perfusion sequence misdiagnosed as vanishing twin: a case report

2020 ◽  
Vol 10 (1) ◽  
pp. 385
Author(s):  
Jharna Behura ◽  
Ayushi Sinha ◽  
Aafreen Naaz ◽  
Soni Bharti
Keyword(s):  
Conservative Management ◽  
Multiple Pregnancy ◽  
Cardiac Activity ◽  
Laser Coagulation ◽  
Variable Degree ◽  
Arterial Perfusion ◽  
Acardiac Twin ◽  
Trap Sequence ◽  
Twin Reversed Arterial Perfusion ◽  
Pump Twin

Twin reversed arterial perfusion (TRAP) sequence is a specific, rare and severe complication of monochorionic multiple pregnancy, which is characterized by one normal fetus (pump twin) and another with no cardiac activity and variable degree of deficient development of the head and upper limbs. The management of these pregnancies are a real challenge due to the parasitic hemodynamic dependence of the acardiac twin on the pump twin. The aim of management is to maximize the chances of survival of the pump twin with some intervention. The preferred management suggested is elective ultrasound-guided laser coagulation or radiofrequency ablation of the umbilical cord vessels at 11-13 weeks when the survival is 70-75%. Delay in intervention until 16-18 weeks is associated with spontaneous cessation of blood flow in the acardiac twin in 60% of cases and in about 50% of these there is death or brain damage in the pump twin. However, pregnancies diagnosed late need to follow a tailored approach with expectant management. The authors report a case of TRAP twin sequence which on ultrasound was diagnosed as a case of vanishing twin at 20 weeks. Subsequently on follow up ultrasound, it was diagnosed as a trap sequence with the pump twin developing polyhydramnios at 30 weeks. She was counselled regarding the prognosis of the pump twin and she opted for conservative management. Weekly ultrasound and color doppler were done. The amniotic fluid index (AFI) decreased gradually at 33 and 35 weeks, there were no signs of congestive cardiac failure of the pump twin on Doppler studies and she had a spontaneous delivery of a healthy male child and an acardiac anceps fetus at 36weeks and 5 days. The perinatal mortality of a pump twin managed conservatively ranges from 35 to 55%. It is essential to diagnose the presence of trap sequence at an early gestational age through improved imaging techniques to plan a timely and effective intervention to salvage most of the pump twins.

Microwave Ablation for Twin-Reversed Arterial Perfusion Sequence: A Novel Application of Technology

2015 ◽  
Vol 38 (1) ◽  
pp. 35-40 ◽  
Author(s):  
Courtney D. Stephenson ◽  
Lorene A. Temming ◽  
Rebecca Pollack ◽  
David A. Iannitti
Keyword(s):  
Energy Source ◽  
Microwave Ablation ◽  
Rare Complication ◽  
Therapeutic Interventions ◽  
Vascular Connection ◽  
Arterial Perfusion ◽  
Risk Of Death ◽  
Microwave System ◽  
Twin Reversed Arterial Perfusion ◽  
Pump Twin

Introduction: Twin-reversed arterial perfusion sequence is a rare complication of monochorionic pregnancies that is characterized by the presence of an acardiac mass perfused by an apparently normal pump twin. The risk of death to the pump twin has led to a range of therapeutic interventions aimed at separating their vascular connection. We report a novel application of microwave ablation for vessel coagulation in the treatment of twin-reversed arterial perfusion sequence. Material and Methods: Microwave ablation has been adopted by surgical subspecialties as a superior energy source for vessel and tissue ablation as it creates heat without a circuit and has less thermal spread. We describe the use of a 2.45-GHz microwave system using a 1.8-mm antenna to coagulate the intra-abdominal portion of umbilical vessels of the acardiac mass. Results: We report 6 cases of twin-reversed arterial perfusion sequence treated by microwave ablation. All patients were treated with microwave ablation with successful coagulation of intra-abdominal umbilical cord vessels of the acardiac mass with cessation of flow. Discussion: Microwave ablation is an excellent energy source for vessel coagulation due to its thermal properties and can be used effectively in the treatment of twin-reversed arterial perfusion sequence.

Acardiac Twin with Externalized Intestine Adherent to Placenta: Unusual Manifestation of Omphalocele

2004 ◽  
Vol 7 (1) ◽  
pp. 81-85 ◽  
Author(s):  
Shawn Clark Emery ◽  
Keith K. Vaux ◽  
Dolores Pretorius ◽  
Eliezer Masliah ◽  
Kurt Benirschke
Keyword(s):  
Blood Flow ◽  
Cardiac Development ◽  
Past Medical History ◽  
Significant Past Medical History ◽  
Maternal Complications ◽  
Unusual Manifestation ◽  
Arterial Perfusion ◽  
Acardiac Twin ◽  
Twin Reversed Arterial Perfusion ◽  
Normal Twin

TRAP (twin reversed arterial perfusion) syndrome produces an acardiac twin (acardiac monster, acardius, acardiacus, chorioangiopagus parasiticus, etc.). Acardiacs result from monozygotic multiple births in which three anatomic anomalies occur: (1) a fetus' cardiac development is disturbed; (2) artery–artery anastomosis carries blood from a normal (“pump”) twin to the acardiac; (3) vein–vein anastomosis carries blood from the acardiac back to the normal twin. Whether reversal of blood flow in the acardiac results from or causes cardiac dysmorphogenesis has not been resolved. Acardiac twins demonstrate a complex constellation of malformations usually thought to result from reversed blood flow; omphalocele is particularly common. We report monochorionic monoamnionic male twins in which an acardiac twin demonstrated externalized intestines adherent to the placenta. The twins were delivered from a 30-year-old primigravida mother by cesarean section without maternal complications at 33 w. The mother has no significant past medical history. The macerated acardius had a 4-cm long attenuated umbilical cord with indeterminate number of vessels. Structures rostral to the thorax were absent save for one poorly developed hand and arm. The abdomen contained loose mesenchyme and no organs. The entire intestine (21 cm) along with two testes was located in a sac on the surface of the placenta. No histopathologic anomalies of formed structures were identified aside from spatial relationships and incomplete development. The normal twin required no intensive care and is doing well. To our knowledge, this is the first report of externalized intestine, which may represent an unusual consequence of omphalocele.

Acardiac Twin: A Rare Case Report

2016 ◽  
Vol 7 (3) ◽  
pp. 103-104 ◽  
Author(s):  
Nimisha N Srivastava ◽  
Tulsi Bhatia ◽  
Jayshree Narshetty
Keyword(s):  
Case Report ◽  
Preterm Labor ◽  
Rare Case ◽  
Monochorionic Twin ◽  
Arterial Perfusion ◽  
Acardiac Twin ◽  
Rare Case Report ◽  
Diagnostic Modalities ◽  
Twin Reversed Arterial Perfusion ◽  
Normal Twin

Abstract The incidence of multifetal pregnancies has dramatically increased due to assisted reproductive technology. As a result, preterm labor, Preterm premature rupture of the membranes, congenital anomalies and fetal losses are commonly encountered by obstetricians. Despite advances in diagnostic modalities and prenatal care, many times the complications associated with multifetal pregnancies may remain undiagnosed. Complications are more with monochorionic twin gestation due to placental sharing. “Twin – reversed arterial perfusion” sequence or “acardiac twin” is one such complication. This case report presents an antenatally undiagnosed monochorionic twin pregnancy, resulting in preterm delivery of a healthy, normal twin along with an acardiac acephalus co-twin. How to cite this article Srivastava NN, Bhatia T, Narshetty J, Kumar S. Acardiac Twin: A Rare Case Report. Int J Infertil Fetal Med 2016;7(3):103-104.

scholarly journals TWIN REVERSED ARTERIAL PERFUSION SEQUENCE (TRAP);

2017 ◽  
Vol 24 (07) ◽  
pp. 1093-1095
Author(s):  
Mubasher Saeed Pansota ◽  
Muhammad Imran Niaz
Keyword(s):  
Case Report ◽  
Cardiac Failure ◽  
Twin Pregnancy ◽  
Identical Twins ◽  
The Other ◽  
Arterial Perfusion ◽  
Trap Sequence ◽  
Cardiac System ◽  
Twin Reversed Arterial Perfusion ◽  
Pump Twin

Twin reversed arterial perfusion sequence (TRAP sequence) is a condition thatoccurs only in identical twins that share a placenta (monochorionic), in which one twin lackinga functioning cardiac system “acardiac monster” receives blood from the normally developingtwin called the “pump twin”. This places an enormous demand on the heart putting the pumptwin at risk for cardiac failure. Left untreated, the pump twin will die in 50 percent to 75 percentof cases. Here we present the case report of a 20 years old G2P1at 32 weeks POG with amonochorionic twin pregnancy. One of the twins was “acardiac acephalous” and the other a“pump twin” with mild hydrocephalous.

scholarly journals An incidental rare finding of a TRAP sequence during a caesarean section: A case report

2021 ◽  
Vol 8 (2) ◽  
pp. 264-266
Author(s):  
Shivangi Sharma ◽  
Minal Choudhary
Keyword(s):  
Caesarean Section ◽  
Upper Body ◽  
Arterial Perfusion ◽  
Acardiac Twin ◽  
Trap Sequence ◽  
Arterial Anastomosis ◽  
Umbilical Arteries ◽  
Twin Pregnancies ◽  
Normal Twin ◽  
Pump Twin

Twin reversed arterial perfusion (TRAP) sequence is an anomaly of monochorionic twin pregnancies where one twin has an absent, non-functioning or rudimentary heart while the other twin may be normal. The condition occurs because of early development of arterio -arterial anastomoses between the umbilical arteries of twin foetuses that share a fused placenta. In this condition, the affected anomalous (acardiac twin) is perfused by the normal twin (pump twin) via an arterio-arterial anastomosis. The affected twin (acardiac twin) presents with malformations such as absent (acradia) or rudimentary heart, underdeveloped or missing head, upper body and limbs. As pump twin has to provide circulation to itself as well as the perfused twin, this increased burden to perfuse acardiac twin increases the risk of developing cardiac failure in pump twin. Here we present such a case of 22-year-old, which was diagnosed per operatively during caesarean section at department of obstetrics & gynecology, Rukshamaniben General Hospital, Ahmedabad.

TRAP) Secuencia de perfusión arterial reversa en embarazo gemelar monocoriónico con feto acárdico. Caso Clínico.

2020 ◽  
Vol 1 (1) ◽  
Author(s):  
Edwin Vargas Llerena ◽  
Severino Rey ◽  
German Herrera ◽  
Alexandra Robayo
Keyword(s):  
English Literature ◽  
Perinatal Outcomes ◽  
It Management ◽  
Second Trimester ◽  
Arterial Perfusion ◽  
Acardiac Twin ◽  
Trap Sequence ◽  
Twin Reversed Arterial Perfusion ◽  
Normal Twin ◽  
Made In

Objetive: Develop a review of the pathophysiology, diagnosis, treatment and management of reversed arterial perfusion.The reversed arterial perfusion sequence, known in English literature as TRAP sequence (twin reversed arterial perfusion (1), pathology associated with complications of monochorionic twin pregnancy, (2) is the absence of a well-defined cardiac structure on a twin (the acardiac twin), which is kept alive by his co-twin (the pump twin) through an arterial-arterial surface placental anastomosis. (3) the normal twin accompanying the acardiac has a mortality of 60% ; morbidity is mainly associated with congestive heart failure (4) while the acardiac twin has a mortality of 100% Apropos of a case reversed arterial perfusion syndrome TRAP diagnosed in the second trimester of pregnancy will be displayed and evaluate it. Management made in the service of Gynecology, service image and Pathology service and the associated perinatal outcomes. Keywords: acardic Fetus, perfusion sequence reversed arterial, sequence TRAP, monochorionic pregnancy twin

scholarly journals Acardiac Acephalus Twin Pregnancy

2019 ◽  
Vol 10 (1) ◽  
pp. 89-91
Author(s):  
Shamim Rima ◽  
Gule Tajkia ◽  
Sharmin Siddika ◽  
Md Tarik Aziz ◽  
Rumana Amin ◽  
...  
Keyword(s):  
Blood Supply ◽  
Umbilical Artery ◽  
Monozygotic Twins ◽  
The Body ◽  
Upper Body ◽  
Arterial Perfusion ◽  
Medical College ◽  
Acardiac Twin ◽  
Twin Reversed Arterial Perfusion ◽  
Pump Twin

Occurrence of acardiac twin is due to twin reversed arterial perfusion sequence (TRAP) occurring early in embryogenesis. There is vascular communication between the twins in monozygotic twins. The vascular communication in acardiac twin is different, in that, the acardiac twin receives blood supply from other twin pump through umbilical artery. The blood in the umbilical artery is mostly deoxygenated. Hence it leads to secondary organ atrophy. Upper body does not develop at all, hence missing heart and head. All the blood supply to the acardiac twin is derived from the pump twin. The acardiac twin develops only lower part of the body or just a mass of tissue. Hence, the mortality for acardiac twin is 100%. Anwer Khan Modern Medical College Journal Vol. 10, No. 1: Jan 2019, P 89-91

scholarly journals Acardiac Acephalus with Single Umbilical Artery in Acardiac Twin

2013 ◽  
Vol 4 (3) ◽  
pp. 93-95
Author(s):  
Sampath Kumar Govindraj ◽  
Rajini Thimmaiah
Keyword(s):  
Early Diagnosis ◽  
Ventricular Hypertrophy ◽  
Umbilical Artery ◽  
Single Umbilical Artery ◽  
Arterial Perfusion ◽  
Acardiac Twin ◽  
Proper Management ◽  
Trap Sequence ◽  
Twin Reversed Arterial Perfusion ◽  
Pump Twin

ABSTRACT Twin reversed arterial perfusion (TRAP) sequence (acardiac twin) is one of the rare complications of multifetal gestation which is unique to monochorionic placentation. It affects about 1% of multifetal gestation and prevalence is one in 35,000 pregnancies. We are presenting a case of acardiac acephalus with ventricular hypertrophy and polyhydramnios of pump twin. Autopsy of acardiac twin was done and various anomalies associated with it were described. Acardiac twin showed anomalies consistent with VACTERL anomalies and single umbilical artery. This case is reported because of the rarity of presentation and to stress the importance of early diagnosis for the proper management of the case. This is taken as an opportunity to describe various modalities of treatment of acardiac twin. How to cite this article Muralidhar L, Govindraj SK, Venkatesh S, Thimmaiah R. Acardiac Acephalus with Single Umbilical Artery in Acardiac Twin. Int J Infertility Fetal Med 2013; 4(3):93-95.

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