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.

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 Acardia anceps: the monster twin; twin reversed arterial perfusion (TRAP) syndrome

2018 ◽  
Vol 7 (11) ◽  
pp. 4775
Author(s):  
Shazia Khan ◽  
Tina Singh ◽  
Gunadhar Maiti
Keyword(s):  
Imaging Techniques ◽  
Rare Complication ◽  
Cardiac Activity ◽  
Well Being ◽  
Reverse Direction ◽  
Arterial Perfusion ◽  
Trap Sequence ◽  
Twin Reversed Arterial Perfusion ◽  
Live Baby ◽  
Pump Twin

Twin reversed arterial perfusion (TRAP) sequence is an extremely rare complication of monochorionic multi-foetal pregnancy, occurring once in 35,000 births. It is characterized by a malformed foetus without a heart being perfused by a structurally normal (pump) twin via an artery-to-artery anastomosis in a reverse direction. We report one such case where ultrasound imaging revealed monochorionic twin pregnancy with a viable, normal-appearing first twin and a structurally aberrant second twin with absent cardiac activity. The patient was monitored with two weekly ultrasonography and Doppler ultrasound examination to ascertain the well-being of the pump twin. She delivered successfully at term a normal live baby and an acardius anceps foetus. The perinatal mortality of the pump twin ranges from 35 to 55%; making it essential to diagnose the presence of a pump twin at an early gestational age through improved imaging techniques to plan effective intervention at appropriate time.

scholarly journals Twin Reversed Arterial Perfusion Sequence: A Rare Entity

2015 ◽  
Vol 5 ◽  
pp. 9
Author(s):  
Sachin Khanduri ◽  
Saakshi Chhabra ◽  
Anshul Raja ◽  
Saurav Bhagat
Keyword(s):  
Gestational Age ◽  
Imaging Techniques ◽  
Rare Complication ◽  
Well Being ◽  
Reverse Direction ◽  
Intrauterine Pregnancy ◽  
Arterial Perfusion ◽  
Trap Sequence ◽  
Twin Reversed Arterial Perfusion ◽  
Pump Twin

Twin reversed arterial perfusion (TRAP) sequence is an extremely rare complication of monochorionic multi-fetal pregnancy, occurring once in 35,000 births. This condition is characterized by a malformed fetus without a cardiac pump being perfused by a structurally normal (pump) twin via an artery-to-artery anastomosis in a reverse direction. We report a case of a primigravida, who came for routine antenatal checkup to our hospital at 31 weeks gestational age. Ultrasound imaging and magnetic resonance imaging revealed twin monochorionic intrauterine pregnancy with a viable, normal-appearing first twin and amorphous structured second twin connected by umbilical vessels. The patient was monitored with weekly ultrasonography, echocardiography, and Doppler ultrasound examination to ascertain the well-being of the pump twin. She delivered successfully at term a normal live baby and an acardius acephalus fetus. Plain X-ray of the acardius acephalus fetus confirmed the absence of cephalic structures. The perinatal mortality of the pump twin ranges from 35 to 55%; hence, it is essential to diagnose the presence of a pump twin at an early gestational age through improved imaging techniques, so that intervention can be planned early in the pregnancy for a better outcome of the pump twin.

MINIMALLY INVASIVE MANAGEMENT OF TWIN REVERSED ARTERIAL PERFUSION SEQUENCE (TRAP)

2006 ◽  
Vol 17 (1) ◽  
pp. 1-22 ◽  
Author(s):  
NJ SEBIRE ◽  
AE WONG ◽  
W SEPULVEDA
Keyword(s):  
Rare Complication ◽  
Intrauterine Death ◽  
Apparent Lack ◽  
Arterial Perfusion ◽  
Trap Sequence ◽  
Arterial Blood ◽  
Underlying Pathophysiology ◽  
Invasive Management ◽  
Twin Reversed Arterial Perfusion ◽  
Pump Twin

Acardiac anomaly, twin reversed arterial perfusion (TRAP) sequence or chorioangopagus parasiticus are synonymous terms referring to a rare complication unique to monochorionic multiple pregnancies in which there is apparent lack of a well-formed cardiac structure in one fetus (the acardiac twin), which is abnormally perfused by a structurally normal co-twin (the pump twin) through a single superficial artery-to-artery placental anastomosis. The condition therefore results in arterial blood flowing in a retrograde fashion from the pump twin towards the affected fetus, and this underlying pathophysiology indicates the preferred use of the clinical term TRAP-sequence. Pathophysiologically, the acardiac fetus acts as a parasite that can only survive in-utero as it is haemodynamically dependent upon the pump twin. The principal perinatal problems being associated with the TRAP sequence are pump-twin congestive heart failure, polyhydramnios and severe preterm delivery, although intrauterine death of the pump twin has been reported even in the absence of such features.

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.

Twin-Reversed Arterial Perfusion Sequence in a Triple Monochorionic Pregnancy with Two Direct Pump Fetuses Results in Significant Cyclic Doppler Waveform

2014 ◽  
Vol 37 (2) ◽  
pp. 157-160 ◽  
Author(s):  
Rocío López-Pérez ◽  
Mónica Lorente ◽  
Juan Martínez-Uriarte ◽  
Inmaculada M. Rivero ◽  
Olivia García-Izquierdo ◽  
...  
Keyword(s):  
Umbilical Cord ◽  
Doppler Ultrasound ◽  
Arterial Perfusion ◽  
Trap Sequence ◽  
Doppler Waveform ◽  
Waveform Pattern ◽  
Direct Pump ◽  
Twin Reversed Arterial Perfusion ◽  
Pump Twin

We report a case of a twin-reversed arterial perfusion (TRAP) sequence complication in monochorionic triplets, in which both normal fetuses were directly connected to the umbilical cord of the acardiac fetus, thus both acting as a pump twin. Doppler ultrasound showed a significant waveform pattern with two superposed systolic waveforms in the same vessel. After birth, placental findings confirmed the existence of two direct pump twins. The Doppler pattern described here may be of help to distinguish the existence of two pump twins in a triplet monochorionic pregnancy with TRAP.

scholarly journals Acardiac Twin

2014 ◽  
Vol 2 (2) ◽  
pp. 77-80 ◽  
Author(s):  
MS Maherunnessa ◽  
Rahima Begum ◽  
Samsad Jahan ◽  
Shamsunnahar Bela ◽  
Syeda Riffat Binta Habib ◽  
...  
Keyword(s):  
Twin Pregnancy ◽  
Umbilical Artery ◽  
Rare Complication ◽  
Multiple Pregnancy ◽  
The Body ◽  
Reverse Direction ◽  
Arterial Perfusion ◽  
Blood Flows ◽  
Acardiac Twin ◽  
Pump Twin

Acardiac anomaly is a rare complication of multiple pregnancies. It is a hemodyamically disadvantaged nonviable twin which occurs in association with a twin reversed arterial perfusion sequence (TRAP). In TRAP, blood flows from an umbilical artery of the pump twin in reverse direction into umbilical artery of the perfused (or acardiac) twin via an arterial to arterial (AA) anastomosis. Its blood is poorly oxygenated and results in variable degrees of deficient development of the head, heart, and upper limb structures. The lower half of the body is usually better developed, which may be explained by the mechanism of perfusion. The pump twin is at risk of heart failure and problems related to preterm birth with a reported mortality of 50-75%. We present a case of multiple pregnancy with acardiac twin in a 26 year old lady with gestational diabetes mellitus. During ante natal check up several ultrasonographic (USG) screening showed twin pregnancy with one healthy fetus and the other fetus with inconspicuous anatomy and structure. Repeat USG at 36th week of gestation diagnosed twin pregnancy with acardiac twin. Strikingly the pump twin did not develop the usual complications and was delivered by cesarean section at 37th week of gestation. DOI: http://dx.doi.org/10.3329/dmcj.v2i2.20529 Delta Med Col J. Jul 2014; 2(2): 77-80

Radiofrequency Ablation with an Internally Cooled Electrode for Twin Reversed Arterial Perfusion Sequence

2016 ◽  
Vol 40 (2) ◽  
pp. 110-115 ◽  
Author(s):  
Maiko Wagata ◽  
Takeshi Murakoshi ◽  
Keisuke Ishii ◽  
Jin Muromoto ◽  
Jun Sasahara ◽  
...  
Keyword(s):  
Radiofrequency Ablation ◽  
Color Doppler ◽  
Fetal Demise ◽  
Arterial Perfusion ◽  
Trap Sequence ◽  
Internally Cooled ◽  
Gestational Age At Delivery ◽  
Twin Pregnancies ◽  
Twin Reversed Arterial Perfusion ◽  
Pump Twin

Objective: The study aims to evaluate the efficacy of radiofrequency ablation (RFA) with an internally cooled electrode for twin reversed arterial perfusion (TRAP) sequence. Methods: From April 2008 through December 2014, we retrospectively reviewed all patients who underwent RFA with an internally cooled electrode for TRAP sequence at 3 tertiary referral centers in Japan. Results: Twenty-five monochorionic diamniotic twin pregnancies underwent RFA with an internally cooled electrode for TRAP sequence at 16-27 weeks of gestation. In all cases, umbilical cord blood flow cessation in the acardiac twin was confirmed by ultrasonography with color Doppler. There were 2 cases of procedure-related complications: 1 case of unintentional septostomy and 1 case of anemia in a pump twin. Fetal demise of the pump twin occurred in 3 (12%) cases. Twenty-two (88%) of 25 pump twins were delivered alive. The median gestational age at delivery was 36 + 3 weeks (range 25 + 2-40 + 5 weeks). There were 14 cases (64%) of premature deliveries before 37 weeks and 5 (23%) before 32 weeks. Conclusion: RFA with an internally cooled electrode is a feasible and effective procedure for the treatment of TRAP sequence.

TRAP (Twin Reversed Arterial Perfusion) sequence

Open Medicine ◽  
2014 ◽  
Vol 9 (3) ◽  
pp. 491-494
Author(s):  
Aleksandra Doronjski ◽  
Taita Stojilković ◽  
Slobodan Spasojević ◽  
Borko Milanović ◽  
Vesna Stojanović
Keyword(s):  
Serum Proteins ◽  
Myocardial Hypertrophy ◽  
Weight Ratio ◽  
Monozygotic Twin ◽  
Fetal Hydrops ◽  
Arterial Perfusion ◽  
Rare Malformation ◽  
Twin Pregnancies ◽  
Twin Reversed Arterial Perfusion ◽  
Pump Twin

AbstractTRAP (Twin Reversed Arterial Perfusion) sequence is a rare malformation that occurs in monozygotic twin pregnancies. Twin weight ratio in our case was 76% (body weight of pump twin was 1800 g, acardiac twin 1370 g), but in spite of that the pump twin had a mild clinical picture with premature birth, fetal hydrops (mild pleural effusion; hypoproteinemia; on the 3rd day of life the baby was without edema and the level of his serum proteins were in referral ranges) and mild myocardial hypertrophy of left ventricle (echocardiography performed on the 28th day of life was normal).

scholarly journals Twin Reversed Arterial Perfusion (TRAP) Syndrome or acardiac twin: a case report in Madagascar

2018 ◽  
Vol 6 (5) ◽  
pp. 1790
Author(s):  
Lyn Z. A. Rabetsimamanga ◽  
Hary F. Rabarikoto ◽  
Maheriandrianina F. V. Rajaonarivony ◽  
Setriny M. Ravoavy ◽  
Hery R. Andrianampanalinarivo
Keyword(s):  
Twin Pregnancy ◽  
Rare Complication ◽  
Cardiac Activity ◽  
Upper Body ◽  
Premature Delivery ◽  
Arterial Perfusion ◽  
Acardiac Twin ◽  
Gestational Week ◽  
Short Time ◽  
Twin Reversed Arterial Perfusion

TRAP syndrome is a rare complication of monochorionic twin pregnancy. It is characterized by the association of an acardiac twin with a healthy twin. The acardiac twin is a parasite who put the healthy twin at high risk of cardiac failure. We report a case in a 25-year-old Malagasy woman, primigravida, who had a consultation at gestational week 31 for significant dyspnea and a threat of premature delivery. Ultrasound scans discovered an acute polyhydramnios, fetus with anasarca and low cardiac activity, and a para-fetal mass. She gives birth to a male newborn and an acardiac twin without head an upper body. The first twin died short time after birth.

Sign in / Sign up

Export Citation Format

Share Document