Monopolar Thermocoagulation of the Major Vessel in an Acardiac Twin

Abstract

An acardiac twin is the most severe form of the twin-to-twin-transfusion syndrome. The pump twin is at high risk for congestive heart failure. Various invasive procedures have been developed to occlude the major vessel in the acardiac twin. We describe successful interruption of blood flow to the acardiac twin with monopolar thermocoagulation at 24 weeks' gestation. The healthy twin was delivered at term.

Zusammenfassung

Eine Zwillingsschwangerschaft mit Acardius-Acranius stellt die schwerwiegendste Ausprägung eines Zwillings-Transfusions-Syndroms dar. Das Risiko für ein Herzversagen des „Spender-Zwillings“ mit intrauterinem Fruchttod ist sehr hoch. Verschiedene invasive Techniken wurden beschrieben, um die Blutversorgung des Acardius-Acranius zu unterbrechen. Wir beschreiben hier den erfolgreichen Einsatz einer monopolaren Koagulation des Hauptgefäßes eines Acardius-Acranius in der 24. Schwangerschaftswoche. Der gesunde Zwilling wurde am Termin geboren.

Key words

Monochorionic twins - acardiac - feticide - twin-to-twin transfusion syndrome - monopolar thermocoagulation

Schlüsselwörter

Monochoriale Zwillinge - Acardius-Acranius - feto-fetales Transfusionssyndrom - monopolare Thermokoagulation - Fetocid

References

• 1 Van Allen M I, Smith D W, Shepard T H. Twin reversed arterial perfusion (TRAP) sequence: study of 14 twin pregnancies with acardius.  Semin Perinatol. 1983;  7 285-293
• 2 Moore T R, Gale S, Benirschke K. Perinatal outcome of forty-nine pregnancies complicated by acardiac twinning.  Am J Obstet Gynecol. 1990;  163 907-912
• 3 Healey M G. Acardia: predictive risk factors for the co-twin's survival.  Teratology. 1994;  50 205-213
• 4 Sogaard K, Skibsted L, Brocks V. Acardiac twins: pathophysiology, diagnosis, outcome and treatment.  Fetal Diagn Therap. 1999;  14 53-59
• 5 Severn C B, Holyoke E A. Human acardiac anomalies.  Am J Obstet Gynecol. 1973;  116 358-365
• 6 McCurdy C M. Jr., Childers JM, Seeds JW. Ligation of the umbilical cord of an acardiac-acephalus twin with an endoscopic intrauterine technique.  Obstet Gynecol. 1993;  82 708-711
• 7 Lemery D J, Vanlieferingham P, Gary M, Finkeltin J, Beaufort A M. Fetal umbilical cord ligation under ultrasound guidance.  Ultrasound Obstet Gynecol. 1994;  4 399-401
• 8 Foley M R, Clewell W H, Finberg H J, Mills M D. Use of the Foley Cordostat grasping device for selective ligation of the umbilical cord of an acardiac twin: a case report.  Am J Obstet Gynecol. 1995;  172 212-214
• 9 Porreco R P, Barton S M, Haverkamp A D. Occlusion of umbilical artery in acardiac, acephalic twin.  Lancet. 1991;  337 326-327
• 10 Sepulveda W, Bower S, Hassan J, Fisk N M. Ablation of acardiac twin by alcohol injection into the intra-abdominal umbilical artery.  Obstet Gynecol. 1995;  86 680-681
• 11 Ville Y, Hyett J A, Vandenbussche F PHA, Nicolaides K H. Endoscopic laser coagulation of umbilical cord vessels in twin reversed arterial perfusion sequence.  Ultrasound Obstet Gynecol. 1994;  4 396-398
• 12 Deprest J A, Audibert F, Van-Schoubroeck D, Hecher K, Mahieu-Caputo D. Bipolar coagulation of the umbilical cord in complicated monochorionic twin pregnancy.  Am J Obstet Gynecol. 2000;  182 340-345
• 13 Rodeck C, Deans A, Jauniaux E. Thermocoagulation for the early treatment of pregnancy with an acardiac twin.  N Engl J Med. 1998;  339 1293-1295
• 14 Hecher K, Campbell S, Doyle P, Harrington K, Nicolaides K. Assessment of fetal compromise by Doppler ultrasound investigation of the fetal circulation. Arterial, intracardiac, and venous blood flow velocity studies.  Circulation. 1995;  91 129-138
• 15 Zikulnig L, Hecher K, Bregenzer T, Baz E, Hackeloer B J. Prognostic factors in severe twin-twin transfusion syndrome treated by endoscopic laser surgery.  Ultrasound Obstet Gynecol. 1999;  14 380-387