Radiofrequency Ablation and Intrauterine Transfusion in a Delayed Diagnosed Acardiac Twin Pregnancy.

Twin reversed arterial perfusion (TRAP) sequence or acardiac twin is a rare and severe complication of monochorionic multiple pregnancies. Acardiac twin accounts for 10% of all TRAP sequences, which is the most morphologically developed acardius. We present an undiagnosed TRAP sequence case up to 24 weeks of gestation who underwent successful amnioreduction, radiofrequency ablation (RFA), and intrauterine transfusion (IUT). During follow-up, hydrops of surviving co-twin disappeared, and fetal heart function improved. Finally, a healthy girl weighing 2400 g was born at 36 weeks of gestation. To our knowledge, this is the first reported acardiac twin pregnancy, which requires IUT, in addition to RFA, due to late diagnosis. Therefore, this case report presents successful management options for TRAP sequence cases diagnosed late in pregnancy.

Duodenal Obstruction during Pregnancy.

Intractable vomiting and elevated liver enzymes during pregnancy seem to be associated to the obstetric etiologies; however, other causes such as acute surgical emergencies should be considered. The patient was a 26-year-old woman at 18 weeks of gestation with intractable vomiting, intolerability of oral intake, weight loss, and absence of abdominal pain. Her physical examinations and laboratory tests had no remarkable findings except elevated liver function test (LFT) and hypokalemia. Considering the lab data and normal abdominopelvic ultrasound, magnetic resonance imaging was performed which revealed dilation of the D1-3 and collapse the D4 sections of duodenum. She underwent exploratory laparotomy which confirmed duodenal obstruction caused by Ladd's band. After the Ladd's operation, the patient started oral intake of nutritious, and her LFT decreased to normal ranges. After the last follow-up, she has had gained 18 kg and gave birth at 36 weeks of gestation due to the premature rapture of membranes and delivered a 2 kg small for gestational age otherwise healthy infant. The experience gained from this case was to consider all possibilities (such as small bowel obstruction) and evaluate them in a pregnant patient to consider other causes of nausea, vomiting, and abnormal LFTs in a pregnant patient.

Cardiac Calcified Amorphous Tumor in the Neonatal Period.

Calcified amorphous tumor (CAT) of the heart is a rare nonneoplastic cardiac mass that may exhibit symptoms resembling malignancy. In this report, we presented a 4-month-old male baby with repeated attacks of cyanosis and a cardiac murmur. Echocardiography revealed a tumoral noncircumscribed mass in the right atrium adhering to the interatrial septum which extends to the inferior vena cava. Cardiac exploration was carried out to excise the tumor. A histopathological study demonstrated the presence of thrombus-like tissue with extensive calcification and foreign body type giant cell reactions. After operation, the patient had an uneventful hospitalization. Although CAT is mainly diagnosed in adult patients, it should be considered in the causes of cardiac mass in the neonatal period.