Successful intrauterine treatment with radiofrequency ablation in a case of twin reversed arterial perfusion sequence

摘要

BACKGROUND: Twin reversed arterial perfusion (TRAP) sequence is a rare complication of monochorionic multifetal pregnancies, and affects approximately 1 % of monochorionic twins and it has a prevalence of 1/35000 pregnancies. This condition belongs to the broad spectrum of twin-to-twin transfusion syndrome and is presumed to result from the fused placentation of monochorionic twins, in which vascular anastomoses arise between the arterial circulation of the hemodynamically larger ,pump' twin and that of the recipient ,perfused twin. The severity of this syndrome depends upon the type of anastomoses and the timing of their establishment. Circulation is accomplished by the heart of the pump twin who is at risk of heart failure. Since growth of the acardi-ac twin depends on blood'supply perfused by the pump twin, in cases with overgrowth of the acardiac twin hyperhemodynamics causing heart failure, fetal hydrops and polyhydramnios may be observed in the pump twin. The perfused twin may display severe and sometimes lethal anomalies, such as acardia and acephalus.