Twin reversed arterial perfusion sequence trap sequence occurs when one. Schatz 1898 classified acardia into two main groups. 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. We report a case of twin reversed arterial perfusion diagnosed at the gestational age of 17 weeks. Twin reversed arterial perfusion sequence fetology. Volume 6, issue 4 octoberdecember, 2016 twinreversed arterial perfusion sequencesyndrome trap. 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. Twin reversed arterial perfusion syndrome trap sequence, acardiac twinning mechanism most extreme manifestation of ttts umbilical arterialtoarterial anastomosis disruption. Twinreversed arterial perfusion sequencesyndrome trap. Twin reversed arterial perfusion acardiac, amorphus. 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. Volume 6, issue 4 octoberdecember, 2016 twin reversed arterial perfusion sequence syndrome trap.
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. Trap sequence occurs in 1% of monochorionic twin pregnancies and in 1 in 35,000 pregnancies overall. This can be shown on doppler ultrasound by reversal of the acardiac twin umbilical arterial blood i. Twin reversed arterial perfusion trap sequence treatment. However, two important controversies are apparent in the. Twin reversed arterial perfusion trap sequence conditions. Twin reversed arterial perfusion trap syndrome sequence is a rare specific anomaly of twin gestation with fused placentae and umbilical anastomosis.
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. 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. In trap sequence, one twin is usually structurally completely normal. A case of twin reversed arterial perfusion trap sequence was diagnosed at 12.
One twin is usually structurally completely normal. 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. The examination was 24 weeks, one amorph fetus and the other one with heart abnormalities. The normal twin, called the pump twin, drives blood through both fetuses. A reversed arterial flow was noted on a doppler imaging study coming from the larger, apparently normal twin to the smaller, grossly abnormal twin, and a diagnosis of twin reversed arterial perfusion sequence was made. Pdf acardiac twinning twin reversed arterial perfusion. Twin reversed arterial perfusion trap sequence is a rare complication specific to monochorionic twin pregnancies. 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 with fetal. Twin reversed arterial perfusion wikimedia commons. Twin reversed arterial perfusion syndrome is mostly seen in monochorionic diamniotic twin pregnancies with an estimated incidence of 195001 pregnancies. The parasitic twin, little more than a torso with or without. Twin reversed arterial perfusion trap syndrome is a rare condition 0.
Twin reversed arterial perfusion trap sequence is a rare complication of monozygotic multiple pregnancy. The presence of an acardiac twin occurs in one of every 35,000 twin pregnancies. Laser treatment of twintotwin transfusion syndrome twin. 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 trap sequence is a syndrome with poor prognosis, seen only in monochorionic monozygotic twin pregnancies. 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. A cardiac twin or twin reversed arterial perfusion trap sequence is a rare unique complication of monozygotic multiple pregnancy. In addition, a manual search was performed from the reference lists of all. Monoamniotic pregnancies were excluded, as were pregnancies affected by twintwin transfusion syndrome or twinreversed arterial perfusion sequence. Twin pregnancies affected by hydramnios were compared with pregnancies in which the single deepest pocket of amniotic fluid was less than 8 cm.
A case of twin reversed arterial perfusion trap sequence. 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. 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. The acardiac twin is dependent upon the normal twin to provide circulation by means of vascular anastomosis. Pdf twin reversed arterial perfusion trap sequence is an extremely rare complication of monochorionic. Diagnosis and management of twin reversed arterial perfusion trap. 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.
The twin reversed arterial perfusion trap sequence, also known as acardiac twinning, is a unique complication of monochorionic twin pregnancies that occurs in approximately one of 35,000. An acardiac fetus is the most severe malformation seen in humans. Prameela rc, priya r, niveda s, pooja gy and prajwal s. It is an extremely rare complication, occurring in approximately 1% of all monozygotic twin gestations, with an incidence of. Twin reversed arterial perfusion trap sequence, also known as acardia, is a rare anomaly unique to multiple gestation in which one twin has an absent, rudimentary, or nonfunctioning heart. It requires blood pumped from the normal twin to keep developing, putting the pump fetus at risk of high output cardiac failure. Laser treatment of twintotwin transfusion syndrome. 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. A condition in which one fetus lacks a heart and the other fetus pumps the blood for both. Diagnosis of twin reversed arterial perfusion sequence in the first. If invasive treatment is indicated, the simplicity, safety, and efficacy of the chosen technique.
It is characterized with a recipient fetus exhibiting lethal anomalies including acardia and a pump fetus. The other is an abnormal mass of tissue, consisting usually of legs and a lower body, but no upper body, head or. Forty cases of twin reversed arterial perfusion sequence. Twin reversed arterial perfusion syndrome anna meshkova twin reversed arterial perfusion syndrome ghada mansour, md,mahmoud youssef, md twin reversed arteriap perfusion sequence imane benchiba. Case report twin reversed arterial perfusion trap sequence. 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 is a rare complication of monochorionic twins with a prevalence of 1 in 35,000 pregnancies.
Acardiac twinning or twin reverse arterial perfusion trapsequence is a rare complication of monochorionic twin pregnancy. Case report twin reversed arterial perfusion sequence. A rare case of twin reversed arterial perfusion trap. Treatment of twin reversed arterial perfusion sequence by.
Acardiac twin or twin reversed arterial perfusion trap sequence is a rare unique complication of monozygotic multiple pregnancy. She was started on enalapril and nifedipine but she defaulted treatment 2 months before falling. Media in category twin reversed arterial perfusion the following 4 files are in this category, out of 4 total. During this period ultrasound and fetal blood sampling revealed no sign of fetal anemia or. Twin reversed arterial perfusion trap sequence with. Though the acardiacpump twin abdominal circumference ratio was 1. Dec 16, 2002 to our knowledge, this is the first reported case of twin reversed arterial perfusion sequence subsequent to the intrauterine demise of one twin in twin. 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. Optimal method and timing of intrauterine intervention in twin. Twin reversed arterial perfusion trap sequence is a rare complication of monochorionic twin pregnancies occurring in 1% of monochorionic twins. In this disorder, there is a normally formed donor the pump. It is a severe variant of twintotwin transfusion syndrome ttts. Trap stands for twin reversed arterial perfusion sequence, and it happens rarely in twin monochorionic pregnancies. Whether to start elective or therapeutic treatment in trapsequence is still controversial.
In the present case, acardiac twin was not diagnosed till her delivery at 39 weeks. Laser ablation of all placental vascular anastomoses is the optimal treatment for twintwin transfusion syndrome ttts. It is characterized by a structurally normal twinpump. Acardiac twinning, or the twin reversed arterial perfusion trap sequence, occurs in 1% of monozygotic. Perinatal outcome of conservative management versus fetal intervention for twin reversed arterial perfusion sequence with a small acardiac twin. Trap sequence is a very rare condition that only occurs in twin pregnancies that share a common placenta. Birth defects seen in only one of a monozygotic mz twin pair. One twin, called the acardiac twin or trap fetus, is. Twinreversed arterial perfusion trap sequence cincinnati. 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.
Acardiac twinning twin reversed arterial perfusion sequence. Twin reversed arterial perfusion acardiac, amorphus dominique thomas, md. What is twin reversed arterial perfusion trap sequence. The twins are joined by a large blood vessel between their umbilical cords. 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 per. Such occurrences are brought about when a normal twin donates blood to an. Trap sequence occurs when there is a monochoriotic pregnancy in which the. Twin reversed arterial perfusion trap sequence is a rare complication of monochorionic pregnancies. This can be achieved by inutero techniques where treatment revolves around. 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. As a result, the heart of the pump twin does extra work to sustain both fetuses and is at risk for heart failure. Jan 12, 2014 twin reversed arterial perfusion trap syndrome is a rare condition 0. 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, also sometimes called trap syndrome is a condition that occurs only in identical twins that share a placenta monochorionic, in which one twin. Trap sequence or acardiac twin ucsf fetal treatment center. A 24yearold caucasian woman presented at 11 weeks gestation with a monochorionic, monoamniotic twin pregnancy. 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.
Dec 03, 2015 jelin e, hirose s, rand l, curran p, feldstein v, guevaragallardo s, jelin a, gonzales k, goldstein r, lee h. Two weeks later, further testing detected a serious problem called twin reversed arterial perfusion, or trap sequence. Twin reversed arterial perfusion syndrome anna meshkova twin reversed arterial perfusion syndrome ghada mansour, md,mahmoud youssef, md twin reversed arteriap perfusion sequence imane. In this disorder, there is a normally formed donor the pump twin. Twin reversed arterial perfusion trap sequence refers to a rare. Twin reversed arterial perfusion sequence trap sequence. In the trap sequence, one twin is not viable, lacking a heart acardiac and defined anatomical features such as a head acephalic. The twins blood systems are connected instead of independent. 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. We report a case of twin reversedarterial perfusion diagnosed at the gestational age of 17 weeks. It is characterized by a structurally normal twinpump perfusing an anomalous recipient twin via an arterytoartery anastomosis in a reverse direction. Trap syndrome is a condition that occurs only in identical twins that share a. 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. Spontaneous cessation of communicating flow in a twin. Pdf summaryacardiac twinning, or the twin reversed arterial perfusion trap sequence, occurs in 1% of monozygotic twins, or 1 in 35000 births. Perinatal outcome of conservative management versus fetal intervention for twin. Case report twin reversed arterial perfusion sequence trap. Twin reversed arterial perfusion sequence sciencedirect. Twin reversed arterial perfusion sequence also called trap sequence, traps, or acardiac twinning is a rare complication of monochorionic twin pregnancies.
The pump twin had respiratory distress syndrome for 3 days after. Twin reversed arterial perfusion syndrome trap or acardiac. Twin reversed arterial perfusion radiology reference. Pdf twin reversed arterial perfusion trap sequence. However, two important controversies are apparent in the literature. This file is licensed under the creative commons attributionshare alike 3. Twin reversed arterial perfusion trap boston childrens. Jelin e, hirose s, rand l, curran p, feldstein v, guevaragallardo s, jelin a, gonzales k, goldstein r, lee h. 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. Twin reversed arterial perfusion trap boston children. We report a unique case of twin reversed arterial perfusion sequence with a prenatal.
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. It develops when the following conditions are present. With frequent ultrasounds, doctors can keep an eye on the normal twins health and identify signs of heart failure. It is called reversed arterial perfusion because in the acardiac twin the blood flows in a reversed direction. 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. However, one of the twins is malformed, and twin as heart is carrying full responsibility for both twins. Twin reversed arterial perfusion trap sequence is a rare complication of multiple pregnancy caused by defects in early embryogenesis. Dec 22, 2006 an acardiac fetus is the most severe malformation seen in humans. Fetal diagnosis and treatment, you and your baby are in the hands of one of the. It is one of the most extreme complications of monozygotic twin pregnancies. Twin to twin transfusion syndrome ttts part 1 pathogenesis duration.