Twin Reversed Arterial Perfusion (TRAP) Sequence: A Case Report and Review of Treatment
Tongta Nanthakomon MD*, Athita Chanthasenanont MD*, Charintip Somprasit MD*, Sakol Manusook MD*, Densak Pongrojpaw MD*, Komsun Suwannarurk MD*
Affiliation : * Department of Obstetrics and Gynecology, Faculty of Medicine, Thammasat University, Pathumthani, Thailand
Acardiac twin or twin reversed arterial perfusion (TRAP) sequence is a rare unique complication of monozygotic multiple pregnancy. 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 well-defined a heart structure. Also evident are other structures, namely the TRAP sequence from pump to acardiac fetus via single artery-to-artery and vein-to-vein anastomoses directly between the two cords or indirectly on the chorionic plate. Overall, the perinatal mortality rate for the pump twin is 35-55%. Prenatal diagnosis and prognosis factors can be examined through ultrasound. The optimal management of acardiac twin pregnancies is controversial. The expected treatment of acardiac anomaly presently relies on maximizing the chance of term delivery and preventing CHF in the healthy pump twin or interrupting vascularization between the two twins. This article reported the experience of acardiac twin management in Thammasat University Hospital and reviewed the current knowledge of the condition, prenatal diagnosis, prognosis factor and management options focusing on conservative management compared to invasive treatment.
Keywords : Acardiac twin, TRAP sequence
