Twins, reversed arterial perfusion syndrome luiz eduardo machado, md. Dec 03, 2015 jelin e, hirose s, rand l, curran p, feldstein v, guevaragallardo s, jelin a, gonzales k, goldstein r, lee h. Dec 22, 2006 an acardiac fetus is the most severe malformation seen in humans. Reversed arterial perfusion to the acardiac twin through the umbilical cord was also detected. Treatment of twin reversed arterial perfusion sequence by. Twin, acardiac, acephalus luis izquierdo, md, james smith, md, george gilson, md, gerardo del valle, md, gary joffe, md, molly chatterjee, md, luis curet, md. Dick oepkes at isuogs multiple pregnancy course, london, 12 april 2017. In the trap sequence, one twin is not viable, lacking a heart acardiac and defined anatomical features such as a head acephalic. It is called reversed arterial perfusion because in the acardiac twin the blood flows in a reversed direction. It requires blood pumped from the normal twin to keep developing, putting the pump fetus at risk of high output cardiac failure. Twin reversed arterial perfusion sequence is probably the most severe malformation found in humans. It is an extremely rare complication, occurring in approximately 1% of all monozygotic twin gestations, with an incidence of about 1 in 35,000 births. Twin reversed arterial perfusion sequence also called trap sequence, traps, or acardiac twinning is a rare complication of monochorionic twin pregnancies.
This is the place where the most difficult challenges are faced head on, where the impossible becomes possible, and where families in search of answers find them. In trap sequence, there is a nonviable, acardiac fetus that has multiple anomalies and a pump fetus that feeds this fetus via vascular anastomosis in the placenta. Acardiac twinning is also called trapsequence twin reversed arterial perfusion. Twintwin transfusion syndrome ttts preventing preterm delivery. Twin reversed arterial perfusion trap boston children. Twin reversed arterial perfusion trap sequence managed at. Twin reversed arterial perfusion wikimedia commons.
Jelin e, hirose s, rand l, curran p, feldstein v, guevaragallardo s, jelin a, gonzales k, goldstein r, lee h. Twin reversed arterial perfusion sequence is considered a rare variant of twinto twin. Twin reversed arterial perfusion trap boston childrens. It is one of the most extreme complications of monozygotic twin pregnancies. The procedure is performed through a single puncture in the mothers abdomen. Twin to twin transfusion syndrome ttts part 1 pathogenesis duration. A case report of twin reversed arterial perfusion sequence with expectant management. Though the acardiacpump twin abdominal circumference ratio was 1. Blood flow is from the acardiactwin back to the donor twin through veno venous anastomosis. Twin reversed arterial perfusion radiology reference article. It is also called acardia,acardiac twinning or acardius acephalus and is a very rare condition.
Twinreversed arterial perfusion trap sequence occurs only in the setting of a monochorionic gestation and complicates approximately 1% of monochorionic twin gestations, with an incidence of 1 in 35,000 births. Prameela rc, priya r, niveda s, pooja gy and prajwal s. Trap twin reversed arterial perfusion acronymfinder. Pdf on sep 1, 2009, m i rizzuto and others published twin reversed arterial perfusion trap sequence. Monochorionic twin pregnancy, acardiac twin, trap sequence. Arterio arterial anastomoses between the umbilical cord of the normal and the acardiac twin are responsible for the clinical presentation of a twin reversed arterial perfusion or trap sequence. A case of twin reversed arterial perfusion trap sequence. Fetal interventions for twin reversed arterial perfusion sequence. Twin reversed arterial perfusion sequence trap sequence, also sometimes called trap syndrome is a condition that occurs only in identical twins that share a placenta monochorionic, in which one twin, lacking a functioning cardiac system, receives blood from the. Twin reversed arterial perfusion trap sequence treatment lowrisk cases, where the acardiac twin is small and there is little stress on the pump twins heart, may only require monitoring. Twin reversed arterial perfusion trap sequence case. Jul 22, 2015 twin reversed arterial perfusion trap sequence is a syndrome with poor prognosis, seen only in monochorionic monozygotic twin pregnancies.
We report a unique case of twin reversed arterial perfusion sequence with a prenatal. Case report twin reversed arterial perfusion trap sequence. A rare case of twin reversed arterial perfusion trap. Treatments for twin reversed arterial perfusion trap in. A case of twin reversed arterial perfusion trap sequence managed conservatively. Robert 2 1department of anatomy, amala institute of medical sciences, thrissur, kerala, india. Twin reversed arterial perfusion trap sequence is a rare, unique complication of monochorionic twin pregnancy in which one of the twins with an absent or a nonfunctioning heart acardiac twin is perfused by its own cotwin pump twin via placental arterial anastomosis. Such occurrences are brought about when a normal twin donates blood to an abnormal twin through its umbilical arteries via vascular anastomoses at the level of the placenta, which is termed as twin reversed arterial perfusion sequence traps.
Twinreversed arterial perfusion trap sequence cincinnati. We report a case of twin reversedarterial perfusion diagnosed at the gestational age of 17 weeks. Acardiac twin or trap twin reversed arterial perfusion sequence is a rare. On serial sonographic examinations, the size of the acardiac twin gradually increased to 0. This is commonly referred to as twin reversed arterial perfusion trap sequence, in which the arterial blood flows in a retrograde direction from the pump twin to the re. Boston childrens treatment is aimed at saving the pump twin by separating the circulation between the twins. In trap sequence, one twin is usually developmentally normal and the other twin has a serious condition, either missing a heart. Assessing the role of the correct imaging modality in a rare clinical entity. Twin reversed arterial perfusion trap sequence is a phenomenon with poor prognosis which is seen in 1100 of monochorionic twin pregnancies. Twin reversed arterial perfusion trap sequence case study. Dec 22, 2010 twin reversed arterial perfusion trap sequence is a rare complication of multiple pregnancy caused by defects in early embryogenesis. Twin reversed arterial perfusion syndrome trap, acardius.
Possible complications for the healthy twin are circulatory overload, which can lead to congestive heart failure, polyhydramnios and, thus, preterm. Twin reversed arterial perfusion trap sequence is a rare anomaly that occurs in pregnancies where identical twins share the same placenta the organ that nourishes the fetus in the womb. As a result, the heart of the pump twin does extra work to sustain both fetuses and is at risk for heart failure. Forty cases of twin reversed arterial perfusion sequence. Twin reversed arterial perfusion sequence sciencedirect. Case report twin reversed arterial perfusion sequence trap. This involves cutting the umbilical cord of the acardiac twin. Twin reversed arterial perfusion trap sequence also called acardiac twinning is a very rare problem, occurring in about 1 percent of monochorionic twins, or identical twins who share one placenta. Twins, reversed arterial perfusion syndrome sonoworld. Twinreversed arterial perfusion trap twintotwin transfusion syndrome ttts type 1 diabetes.
The majority of pump twins are congenitally normal, but. Twin reversed arterial perfusion trap sequence conditions. Twin reversed arterial perfusion trap sequence is a rare complication specific to monochorionic twin pregnancies. Twin reversed arterial perfusion sequence springerlink. We report a case of twin reversed arterial perfusion diagnosed at the gestational age of 17 weeks. Twin reversed arterial perfusion trap sequence is a condition in which an acardiacacephalic twin receives all of its blood supply from a normal twin, the socalled pump twin.
In trap sequence, one twin is usually structurally completely normal. The pump twin supplies the acardiac recipient twin with blood, and although the pump twin is usually structurally normal, congenital anomalies have sometimes been reported. Twinreversed arterial perfusion trap is a rare complication of monochorionic twins with a prevalence of 1 in 35,000 pregnancies. More or less large arterial anastomoses on the placental surface pump oxygenpoor blood from the donor twin to the acardiac twin mean that the direction of blood flow in the umbilical cord of the acardiac is reversed as compared to normal. Twin reversed arterial perfusion trap sequence is a rare and severe complication specific to monochorionic twin pregnancies, involving the presence of an acardiac twin and a structurally normal. Twin reversed arterial perfusion acardiac, amorphus dominique thomas, md. Twin reversed arterial perfusion trap sequence is an extremely rare complication of monochorionic multifetal pregnancy, occurring once in. Twin reversed arterial perfusion trap sequence treatment. What is twin reversed arterial perfusion trap sequence. A condition in which one fetus lacks a heart and the other fetus pumps the blood for both. It develops when the following conditions are present. Twinreversed arterial perfusion trap articles related to this keyword. Twin reversed arterial perfusion trap sequence or acardiac twinning is a very rare problem, occurring in approximately 1% of monochorionic twins mc, twins sharing one placenta. However, one of the twins is malformed, and twin as heart is carrying full responsibility for both twins.
It is a severe variant of twintotwin transfusion syndrome ttts. Trap sequence or acardiac twin ucsf fetal treatment center. Synchronized heart beats of 188 beats per minute were evident in both twins. It is characterized by a structurally normal twinpump perfusing an anomalous recipient twin via an arterytoartery anastomosis in a reverse direction. Spontaneous cessation of communicating flow in a twin.
Tailored management of twin reversed arterial perfusion. One twin, called the acardiac twin or trap fetus, is. Acardiac twinning or twin reverse arterial perfusion trapsequence is a rare complication of monochorionic twin pregnancy. The calculated weight ratio of the abnormal to normal twin was 90 percent, placing this pregnancy in the highest risk category for twin reversed arterial perfusion sequence trap sequence in addition to the risks associated with the entangled umbilical cords. The acardiac twin is dependent upon the normal twin to provide circulation by means of vascular anastomosis. An acardiac fetus is the most severe malformation seen in humans. In cases of trap, the mortality rate for the normal pump twin is reported to be approximately 50%. A rare case of twin reversed arterial perfusion trap sequence.
Twin reversed arterial perfusion trap sequence with. Twin reversed arterial perfusion trap sequence occurs only in the setting of a monochorionic gestation and complicates approximately 1% of monochorionic twin gestations, with an incidence of 1 in 35,000 births. In this disorder, there is a normally formed donor the pump twin who has features of congestive heart failure chf as well as a recipient the acardiac twin who lacks a welldefined a heart structure. Jan 12, 2014 twin reversed arterial perfusion trap syndrome is a rare condition 0. Trap stands for twin reversed arterial perfusion sequence, and it happens rarely in twin monochorionic pregnancies. Twin reversed arterial perfusion trap occurs in identical twin pregnancies when one twin has an absent or nonfunctioning heart and receives all of its blood from the normally functioning and developing pump twin. The presence of an acardiac twin occurs in one of every 35,000 twin pregnancies and in 1% of monochorionic twin pregnancies. This malformation happens as a result of the syndrome of reversed arterial perfusion of the acardiac twin from the other normal fetus pump twin, due to the presence of arterio. Twin reversed arterial perfusion trap syndrome is a rare condition 0. Twin reversed arterial perfusion sequence wiley online library. The twins are joined by a large blood vessel between their umbilical cords. Pdf twin reversed arterial perfusion trap sequence. Table 1 clinical details of 12 monochorionic diamniotic twin pregnancies with twin reversed arterial perfusion trap sequence treated by ultrasoundguided intrafetal laser ablation in the. This abnormal twin is kept alive by blood that is pumped from the normal twin through the placenta utilizing arteries to pump blood in a reversed direction to the abnormal twin trap sequence.
This is a acardiac fetus, investigated with 3d ultrasound. Fetal interventions for twin reversed arterial perfusion. Twin reversed arterial perfusion radiology reference. A complication of monozygotic twin pregnancies in which one fetus develops normally. Firsttrimester intervention in twin reversed arterial. Twin reversed arterial perfusion trap sequence refers to a rare complication unique to monochorionic twin pregnancies in which a twin with. The first image demonstrates the pump twin on top and the acardiac below. Trap sequence occurs in 1% of monochorionic twin pregnancies and in 1 in 35,000 pregnancies overall. The parasitic twin, little more than a torso with or without legs, receives its blood supply from the host twin by means of an umbilical cordlike structure, much like a fetus in fetu, except the. As a result of early vascular disruption occurring during embryogenesis, a dysmorphic acardiac twin receives circulatory support from a pump twin via aberrant placental arterioarterial anastomoses. Twins prenatal care algorithm in trap sequence, one twin is usually developmentally normal and the other twin has a serious condition, either missing a heart acardiac or a head acephalic or both, that prevents it from surviving on its own. Perinatal outcome of conservative management versus fetal intervention for twin reversed arterial perfusion sequence with a small acardiac twin. Diagnosis and management of twin reversed arterial perfusion trap.
This condition is characterized by a malformed fetus without a cardiac pump being perfused by a structurally normal pump twin via an arterytoartery anastomosis in a reverse direction. Twin reversed arterial perfusion syndrome trap or acardiac. Surgical management of twin reversed arterial perfusion. Arterioarterial anastomoses between the umbilical cord of the normal and the acardiac twin are responsible for the clinical presentation of a twin reversed arterial perfusion or trap sequence. The examination was 24 weeks, one amorph fetus and the other one with heart abnormalities. Twin reversed arterial perfusion trap is a rare complication of monochorionic twins with a prevalence of 1 in 35,000 pregnancies. Twin reversed arterial perfusion sequence trap sequence. Twin reversed arterial perfusion trap sequence with fetal. Treatments for twin reversed arterial perfusion trap in children. With frequent ultrasounds, doctors can keep an eye on the normal twins health and identify signs of heart failure. It is characterized with a recipient fetus exhibiting lethal anomalies including acardia and a pump fetus. Twin reversed arterial perfusion trap sequence is a rare complication of monochorionic twin pregnancies occurring in 1% of monochorionic twins.
Twin, acardiac, acephalus cases, lectures, articles, cmes. This phenomenon is known as twin reversed arterial perfusion, and had not previously been reported in the medical literature in conjunction with conjoined twinning. It is a rare complication that affects 1 in 100 monozygotic twin pregnancies and 1 in 35,000 overall, with no. One twin is usually structurally completely normal. The twin reversed arterial perfusion is a rare condition with a nonviable acardiac twin and a lot of risks to the pump twin prematurity, cardiac failure, hydrops and intrauterine demise. Twin reversed arterial perfusion trap sequence is a syndrome with poor prognosis, seen only in monochorionic monozygotic twin pregnancies. For 150 years, families have come from around the corner and across the world, looking to boston childrens for answers. Twin reversed arterial perfusion trap sequence managed. The twin reversed arterial perfusion, or trap sequence, results in an acardiac twin, a parasitic twin that fails to develop a head, arms and a heart. Trap sequence is a very rare condition that only occurs in twin pregnancies that share a common placenta monochorionic twins. Fetal interventions for twin reversed arterial perfusion sequence fetal interventions for twin reversed arterial perfusion sequence. Media in category twin reversed arterial perfusion the following 4 files are in this category, out of 4 total. Twin reversed arterial perfusion trap sequence is a rare complication of monozygotic multiple pregnancy. Acardiac twin or twin reversed arterial perfusion trap sequence is a rare unique complication of monozygotic multiple pregnancy.
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