Secuencia de perfusión arterial reversa en embarazo gemelar (TRAP) monocoriónico con feto acárdico

La secuencia síndrome de perfusión arterial reversa (TRAP, por sus siglas en inglés) es una de las patologías asociadas a las complicaciones del embarazo gemelar monocoriónico, que puede mostrar discordancia del volumen de líquido amniótico entre los fetos y hasta coexistencia de un feto acárdico con uno sano. Se comunica el caso de un síndrome de perfusión arterial reversa TRAP diagnosticado en el segundo trimestre del embarazo y se discute el manejo realizado en el servicio, así como los resultados perinatales asociados.

Twin reverse arterial perfusion (TRAP) sequence is a pathology associated to monochorionic twin pregnancy complications that may show amniotic fluid volume discordance between fetuses and even coexistence of one acardiac fetus and one healthy fetus. A TRAP case diagnosed in the second trimester of pregnancy is reported and treatment and perinatal results are discussed.

A Case of Acardiac Fetus in a Triplet Pregnancy / 대한산부인과학회잡지

Acardiac fetus in triplet pregnancy is a very rare, fatal congenital anomaly that had not been reported in Korea. It only occurs in multiple gestations associated with placental vascular anastomoses between the affected fetus and its co-twin. The major complications associated with acardiac fetus in triplet pregnancy are congestive heart failure in normal pumping fetus, maternal polyhydramnios, preterm labor, intrauterine fetal death, etc, and perinatal diagnosis can be made with the perinatal ultrasonographic examination. We report a case of acardiac fetus in a spontaneous triplet pregnancy at 23 weeks of gestational age with a brief review of the literature.

Acardiac twins: an analysis of 10 cases

The pathological characteristics of the acardiac fetus were studied based on 10 autopsy cases. These cases were collected during a 13-year period at Seoul National University Hospital. All 10 fetuses were monochorionic twins, and six of them were male. Externally normal co-twins survived in five cases and died perinatally in three cases. The gestational period of these acardiacs ranged from 20 to 33 weeks. All of them showed a growth arrest of a fairly wide spectrum. Four cases belonged to acardius anceps, five were acardius acephalus, and one was acardius amorphus. Nine out of 10 cases were holoacardius, whereas one was hemiacardius with a vestigial heart tube present. Characteristic artery-to-artery anastomoses were demonstrated in all cases where examination was possible. The umbilical cords of the acardiacs often consisted of only two vessels, i.e., one umbilical artery and one umbilical vein, and these vessels were directly attached to the arteries and veins of the normal co-twins on the placental surface. The vascular system of the acardiac fetuses was simplified, providing only inflow and outflow pathways through common iliac vessels and vitelline vessels. When the head part was preserved (acardius anceps), the facial features were indistinguishable, particularly in the midfacial region, which resulted in a characteristic holoprosencephalic malformation of the brain in two out of four cases. Normal eyeball structure was not noted in any of these cases. The oral cavity and tongue were rarely recognized. Once the head part was absent (acardius acephalus) there was a wide variation of thoracic organ development. Hypoplastic lungs were seen in three cases, and they were connected to the trachea. A tracheoesophageal fistula was seen twice. The gastrointestinal tract was the most common feature of these acardiac monsters. However, it often lacked some portions, such as a stomach, midgut or part of a large intestine. The kidneys, testes and other parts of the urinary system were other common constituents of the acardiacs.