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.

scholarly journals A Case of Monochorionic-Triamniotic Triplet Pregnancy with TRAP Sequence Successfully Treated with Radiofrequency Ablation with a Parallel Circuit Consisting of Anastomosed Blood Vessels between the Direct Pump Fetus and the Indirect Pump Fetus

2019 ◽  
Vol 2019 ◽  
pp. 1-4
Author(s):  
Shusaku Kobori ◽  
Masatake Toshimitsu ◽  
Shinichi Nagaoka ◽  
Jun Murotsuki
Keyword(s):  
Radiofrequency Ablation ◽  
Blood Vessels ◽  
Multiple Pregnancy ◽  
Triplet Pregnancy ◽  
Arterial Perfusion ◽  
Trap Sequence ◽  
Parallel Circuit ◽  
Twin Pregnancies ◽  
Direct Pump ◽  
Twin Reversed Arterial Perfusion

Monochorionic-triamniotic triplet pregnancy with twin reversed arterial perfusion (TRAP) sequence is one of the rare complications of multiple pregnancy and has been reported by only a few. Here, we report a case of monochorionic-triamniotic triplet pregnancy with TRAP sequence successfully treated with radiofrequency ablation, which did not develop polyhydramnios and heart failure although the estimated weight of the acardiac fetus increased twice as much as that of the direct pump fetus. Interestingly, the anastomosed blood vessels between the direct and indirect pump fetuses comprised a parallel circuit, which provided blood flow to the acardiac fetus. We hypothesized that the burden on the pump fetus in monochorionic pregnancy with TRAP sequence would be different between triplet and twin pregnancies.

scholarly journals TRAP Sequence - An Interesting Entity in Twins

2012 ◽  
Vol 2 ◽  
pp. 56 ◽  
Author(s):  
R. H. Srinivas Prasad ◽  
T. Ramachandra Prasad ◽  
K. Dayananda Kumar
Keyword(s):  
Color Doppler ◽  
Color Doppler Imaging ◽  
Doppler Imaging ◽  
Arterial Perfusion ◽  
Prognostic Features ◽  
Trap Sequence ◽  
Rare Malformation ◽  
Twin Reversed Arterial Perfusion ◽  
Pump Twin

Twin reversed arterial perfusion (TRAP) sequence, is a rare malformation occurring in monozygotic multiple gestations. One well-developed normal (pump) twin and the other twin with absent cardiac structure (acardiac), who is hemodynamically dependent on the normal (pump) twin are characteristic of this syndrome. The acardiac twin develops multiple anomalies that make survival difficult. The prognosis of the pump twin is variable with mortality rate ranging from 50% to 70%. Complications that affect the prognosis of the pump twin include complications of congestive cardiac failure due to increased cardiac demand, prematurity secondary to preterm delivery, and polyhydramnios. Because of these complications prompt detection, follow-up, and treatment of this condition is very important. We report two cases of TRAP sequence that emphasizes the importance of gray-scale and color Doppler imaging in diagnosis, detection of poor prognostic features, follow-up, and management of TRAP sequence.

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.

Twin reversed arterial perfusion (TRAP) sequence managed at 11+6 weeks with radiofrequency ablation

2014 ◽  
Vol 3 (2) ◽  
Author(s):  
Gwangjun Kim ◽  
Min Young Park ◽  
Seung Su Han
Keyword(s):  
Case Report ◽  
Radiofrequency Ablation ◽  
Gestational Age ◽  
Feeding Artery ◽  
First Line ◽  
Arterial Perfusion ◽  
Trap Sequence ◽  
Twin Reversed Arterial Perfusion ◽  
Line Management

AbstractRadiofrequency ablation (RFA) has become widely accepted as first-line management for twin reversed arterial perfusion (TRAP) sequence. Most RFA procedures have been performed using RFA needles of 14–17 gauge (G) focusing on an acardiac mass at an average age of 21 weeks of gestation (17–24 weeks). In this case report, we describe treatment of TRAP sequence using RFA with a 20 G needle focusing a feeding artery on the placental surface at gestational age of 11+6.

Intrafetal Laser Coagulation for Trap Sequence in a Complicated Dichorionic Triamniotic Triplet Pregnancy Case Report and Review of the Literature

2017 ◽  
Vol 10 (2) ◽  
pp. 146-150
Author(s):  
Petya P. Chaveeva ◽  
Slavcho T. Tomov ◽  
Atanas D. Shterev
Keyword(s):  
Pregnancy Outcome ◽  
Color Doppler ◽  
First Trimester ◽  
Laser Coagulation ◽  
Triplet Pregnancy ◽  
Vitro Fertilization ◽  
Arterial Perfusion ◽  
Trap Sequence ◽  
Twin Reversed Arterial Perfusion

Summary A rare case is reported of twin-reversed arterial perfusion (TRAP) sequence in a triplet pregnancy, fetal intervention in the first trimester and pregnancy outcome. We report a case of TRAP sequence complication in dichorionic triamniotic triplet pregnancy, with a normally developing fetus and an acardiac fetus connected via arterio-arterial anastomoses in a monochorionic diamniotic twin pair and a separate fetus. TRAP sequence was diagnosed at 13 weeks in triplet pregnancy after in vitro fertilization (IVF) and embryo transfer of two blastocysts. Color Doppler assessment showed persistent arterial flow in the acardiac twin. Intrafetal laser coagulation was carried out at the time of the diagnosis, and the pregnancy outcome was two survivals at 36.4 weeks of gestation.

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.

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 Acardiac-acephalus Twinning- A Very Rare Case Report

2020 ◽  
Vol 32 (2) ◽  
pp. 143-144
Author(s):  
Parvez Ahmed ◽  
Nasrin Begum ◽  
Mostofa Shamim Ahsan ◽  
Mosharruf Hossain ◽  
Munshi Md Arif Hosen ◽  
...  
Keyword(s):  
Case Report ◽  
Rare Case ◽  
Severe Form ◽  
Monochorionic Twin ◽  
Arterial Perfusion ◽  
Trap Sequence ◽  
Rare Case Report ◽  
Medicine Today ◽  
Twin Pregnancies ◽  
Twin Reversed Arterial Perfusion

Introduction:This study highlights a very rare case which was related to abnormal monochorionic twinning status. Case Report: This case (a 28 year old pregnant woman) came at this institute for ultrasonographic evaluation of herpregnancy status. Her ultrasonographic results were consistent with acardiac-acephalus twinning condition (which isalso known as, twin reversed arterial perfusion or TRAP sequence). Discussion: This monochorionic twin pregnancy isa severe form of twin-to-twin transfusion syndrome (TTTS) and severe TTTS has mortality rate of about 60–100%. Conclusion: This case is very rare showing prevalence of about 1/35,000 overall pregnancies and accounting 1.0% ofthe monochorionic twin pregnancies. Medicine Today 2020 Vol.32(2): 143-144

scholarly journals Twin reversed arterial perfusion sequence in a monochorionic monoamniotic twin pregnancy: a very rare condition

2020 ◽  
Vol 51 (1) ◽  
Author(s):  
Abolfazl Abouie ◽  
Nima Rakhshankhah ◽  
Ladan Younesi ◽  
Zeinab Safarpour ◽  
Ayda Roostaee ◽  
...  
Keyword(s):  
Twin Pregnancy ◽  
Cardiac Activity ◽  
Rare Condition ◽  
Case Presentation ◽  
Arterial Perfusion ◽  
Trap Sequence ◽  
Fetal Surveillance ◽  
History Of ◽  
Twin Reversed Arterial Perfusion ◽  
Pump Twin

Abstract Background Twin reversed arterial perfusion sequence (TRAP) is a very rare congenital anomaly. We present sonographic findings of TRAP sequence in the case of a multiparous woman with a monochorionic monoamniotic twin pregnancy who was referred to our unit for blood sugar control. Case presentation The patient had a history of co-twin demise at 13 weeks of gestation without appropriate fetal surveillance afterwards. We found a monochorionic placentation with a normal appearing pump twin, an abnormal appearing co-twin without obvious cardiac activity and reversed arterial flow toward instead of away from the anomalous acardiac fetus. Therefore, the sonographic diagnosis of TRAP sequence was confirmed. Conclusions We recommend considering the potential rare complications of monochorionic twin pregnancy which necessitates proper surveillance and intervention to monitor suitable growth of pump twin.

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