This phenomenon is known as twin reversed arterial perfusion, and had not previously been reported in the medical literature in conjunction with conjoined twinning. Pdf twin reversed arterial perfusion trap sequence. A case of trap sequence with immense acardiac twin in. Twin reversed arterial perfusion trap boston childrens.
Forty cases of twin reversed arterial perfusion sequence. We present a case of acardius anephus, which was mistaken for a live anomalous singleton fetus. Twin reversed arterial perfusion trap sequence is a rare complication of monochorionic pregnancies. Perfusion of the anomalous twin occurs by reversal of flow through the umbilical vessels of that twin 2. Arterial spin labeling asl mr perfusion is an mr perfusion technique which does not require intravenous administration of contrast unlike dsc perfusion and dce perfusion. The arterial blood that enters the body of the affected twin is presumably under reduced oxygen tension, which may cause disruption of organ morphogenesis 2, 4. Twin reversed arterial perfusion sequencealso called trap sequence, traps, or acardiac. Twin reversed arterial perfusion trap sequence with fetal. Case report twin reversed arterial perfusion sequence trap. In trap sequence, one twin is usually structurally completely normal. Sixteen patients were managed expectantly survivors, 81%, while six underwent rfa at the time of diagnosis and one later in pregnancy six survivors, 86%. 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. The twins are joined by a large blood vessel between their umbilical cords.
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. Twin reversed arterial perfusion sequence is a rare complication of monochorionic twinning, in which the normal pump twin perfuses the abnormal acardiac twin in a reversed fashion via an artery to. Trap sequence is diagnosed in a monochorionic twin pregnancy if one twin is abnormal with no functional cardiac activity and is reversely. Abstract we report 2 cases of trap sequence diagnosed antenatally using three.
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. Twin reversed arterial perfusion trap sequence is a rare complication of multiple pregnancy caused by defects in early embryogenesis. Twin reversed arterial perfusion johns hopkins center for fetal. Ultrasonographic prenatal diagnosis of isolated acephaly pdf.
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. Rfa radiofrequency ablation, trap reversed arterial perfusion. A rare case of twin reversed arterial perfusion trap sequence. Hsieh, anshine chao, shuenndyh chang, yungkuei soong we report a case of twin reversed arterial perfusion diagnosed at the gestational age of 17 weeks. It is a rare complication that affects 1 in 100 mo nozygotic twin pregnancies and 1 in 35,000 overall, with no recognized familial recurrence 1.
This case highlights the spontaneous cessation of communicating flow in a twin reversed arterial perfusion with large acardiac twin yaolung chang, peter c. Acardiac twin or twin reversed arterial perfusion trap sequence is a rare unique complication of monozygotic multiple pregnancy. Diagnosis and management of twin reversed arterial perfusion trap. An external file that holds a picture, illustration, etc. The twin reversed arterial perfusion trap sequence is an anomaly unique to monochorionic multiple pregnancies. It is one of the most extreme complications of monozygotic twin pregnancies. In group a, 23 cases were diagnosed at a mean gestational age of 19.
It is characterized with a recipient fetus exhibiting lethal anomalies including acardia and a pump fetus. It is called reversed arterial perfusion because in the acardiac twin the blood flows in a reversed direction. 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. Fetus in fetu sometimes is interpreted as a special case of parasitic twin, but may be a distinct entity. What links here related changes upload file special pages permanent link page information wikidata item cite this page. Early vs late intervention in twin reversed arterial. Jul 22, 2015 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 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 normally developing twin called the pump twin. Trap twin reversed arterial perfusion acronymfinder.
Twin reversed arterial perfusion sequence trap sequence. Twin reversed arterial perfusion radiology reference. The twin reversed arterial perfusion trap sequence or acardiac twinning, or chorioangiopagus parasiticus is an anomaly unique to monochorionic multiple pregnancies 1. Twins, reversed arterial perfusion syndrome sonoworld. Case report twin reversed arterial perfusion trap sequence. What is twin reversed arterial perfusion trap sequence. Surgical management of twin reversed arterial perfusion sequence. Twin reversed arterial perfusion trap sequence is a syndrome with poor prognosis, seen only in monochorionic monozygotic twin pregnancies. Early versus late intervention for twin reversed arterial perfusion sequence trapist the safety and scientific validity of this study is the responsibility of the study sponsor and investigators. The twinreversed arterial perfusion trap sequence, also known as acardiac. 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. A rare complication of monochorionic twin pregnancy. Twin reversed arterial perfusion trap sequence is a rare complication of monochorionic multifetal pregnancies, and affects approximately 1% of monochorionic twins with a prevalence of 5000. Increase in 2long terminal repeat circles and decrease in ddimer after raltegravir intensification in patients with treated hiv infection.
The twins blood systems are connected instead of independent. Case 1 was a 44 year old g3a2 mother with monochorionic diamniotic mcda twin pregnancy conceived after in vitro fertilization. Arterial spin labeling mr perfusion radiology reference. 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. Twin reversed arterial perfusion trap sequence conditions. The first image demonstrates the pump twin on top and the acardiac below. A 21yearold unbooked primigravida was seen in labour ward with a ten hours history of labour pains. As a result, the heart of the pump twin does extra work to sustain both fetuses and is at risk for heart failure. Diagnosis of twin reversed arterial perfusion sequence in the first trimester was associated with a high miscarriage rate at or before 16 weeks, especially with a largesize acardiac twin. It arises when the cardiac system of one twin does the.
Instead it exploits the ability of mri to magnetically label arterial blood below the imaging slab. Twinreversed arterial perfusion trap sequence, previously termed acardiac twinning, is a relatively uncommon complication of monochorionic twin pregnancies, affecting 1% of all monochorionic twin gestations 1. 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. Twin reversed arterial perfusion trap sequence refers to a rare complication unique to monochorionic twin pregnancies in which a twin with. 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.
Twinreversed arterial perfusion trap articles related to this keyword. It develops when the following conditions are present. Twinreversed arterial perfusion sequence associated with. 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. It is a severe variant of twintotwin transfusion syndrome ttts. Twin reversed arterial perfusion sequence is considered a rare variant. Twin reversed arterial perfusion trap sequence is a rare condition of monochorionic twin pregnancies. Get the facts about fetal surgery then share this infographic with your friends and family to help raise awareness of the ways babies can be treated for serious and lifethreatening conditions even before theyre born. Spontaneous cessation of communicating flow in a twin. Acardiac twinning or twin reverse arterial perfusion trapsequence is a rare complication of monochorionic twin pregnancy. Twin reversed arterial perfusion trap johns hopkins medicine.
Ethical approval exemption form is attached in the supplemental files. Early diagnosis is essential for improving perinatal prognosis for the normal twin. Twins, reversed arterial perfusion syndrome luiz eduardo machado, md. Twin reversed arterial perfusion sequencealso called trap sequence, traps, or acardiac twinningis a rare complication of monochorionic twin pregnancies. 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. The parameter most commonly derived is cerebral blood flow cbf. 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 trap sequence is a rare condition occurring in approximately 1 in 100 monochorionic twin pregnancies and in 1 in 35000 of all pregnancies. Media in category twin reversed arterial perfusion the following 4 files are in this category, out of 4 total.
Whether to start elective or therapeutic treatment in trapsequence is still controversial. Twin reversed arterial perfusion trap sequence is a rare complication of monochorionic twin pregnancies occurring in 1% of monochorionic twins. In the present case, acardiac twin was not diagnosed till her delivery at 39 weeks. 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. This is a acardiac fetus, investigated with 3d ultrasound.
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. Abstract objective to report the outcome of monochorionic twins with twin reversed arterial perfusion trap sequence following interstitial. We understand the urgency involved with treating a fetus with a diagnosis of trap. A condition in which one fetus lacks a heart and the other fetus pumps the blood for both. The normal twin, called the pump twin, drives blood through both fetuses. Jump to content jump to main navigation jump to main navigation. Trap sequence is a very rare condition that only occurs in twin pregnancies that share a common placenta monochorionic twins. Trap sequence occurs when a normal or pump twin perfuses an acardiac mass via placental vascular connections that are found. Intrafetal laser coagulation for trap sequence in a. Outcome of twin reversed arterial perfusion sequence. Firsttrimester intervention in twin reversed arterial. Trap sequence occurs in 1% of monochorionic twin pregnancies and in 1 in 35,000 pregnancies overall. Twin reversed arterial perfusion wikimedia commons.
All patients with twin reversed arterial perfusion sequence who were seen for consultation between 1993 and 2004 were studied. Twin reverse arterial perfusion sequence request pdf. Acardiac twin twin reversed arterial perfusion trap. Reversed arterial perfusion trap sequence, in which the primary malformation is the lack of a welldefined cardiac structure in one twin acardiac, which is kept alive by its structurally normal co twin pump twin through abnormal placental vascular anastomosis. Criteria for umbilical cord occlusion included abdominal circumference of the twin reversed arterial perfusion fetus that was more than or equal to the pump twin, polyhydramnios maximum vertical pocket. We report a unique case of twin reversed arterial perfusion sequence with a prenatal. Tailored management of twin reversed arterial perfusiontrap.
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