Anh ND, Thu Ha NT, Sim NT, Toan NK, Thuong PTH, Duc NM. Twin reversed arterial perfusion sequence-a rare and dangerous complication form of monochorionic twins: A case report. World J Clin Cases 2022; 10(28): 10214-10219 [PMID: 36246815 DOI: 10.12998/wjcc.v10.i28.10214]
Corresponding Author of This Article
Nguyen Minh Duc, MD, Department of Radiology, Pham Ngoc Thach University of Medicine, 2 Duong Quang Trung Ward 12 District 10, Ho Chi Minh City 700000, Vietnam. bsnguyenminhduc@pnt.edu.vn
Research Domain of This Article
Obstetrics & Gynecology
Article-Type of This Article
Case Report
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Nguyen Duy Anh, Nguyen-Thi Sim, Fetal Medicine Center, Hanoi Obstetrics and Gynecology Hospital, Hanoi 100000, Vietnam
Nguyen-Thi Thu Ha, Department of Assisted Reproduction, Hanoi Obstetrics and Gynecology Hospital, Hanoi 100000, Vietnam
Nguyen Khac Toan, Phan-Thi Huyen Thuong, Department of Obstetrics and Gynecology, Hanoi University of Medicine and Pharmacy, Hanoi 100000, Vietnam
Nguyen Minh Duc, Department of Radiology, Pham Ngoc Thach University of Medicine, Ho Chi Minh City 700000, Vietnam
Author contributions: Anh ND and Thu Ha NT contributed equally to this article; Anh ND and Thu Ha NT contributed to the case file retrieval and case summary preparation; Thuong PHT and Duc NM contributed to the preparation of manuscript and editing; All authors read and approved the final manuscript.
Informed consent statement: All study participants or their legal guardian provided informed written consent about personal and medical data collection prior to study enrolment.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nguyen Minh Duc, MD, Department of Radiology, Pham Ngoc Thach University of Medicine, 2 Duong Quang Trung Ward 12 District 10, Ho Chi Minh City 700000, Vietnam. bsnguyenminhduc@pnt.edu.vn
Received: April 21, 2022 Peer-review started: April 21, 2022 First decision: May 30, 2022 Revised: June 9, 2022 Accepted: August 23, 2022 Article in press: August 23, 2022 Published online: October 6, 2022 Processing time: 158 Days and 20.9 Hours
Abstract
BACKGROUND
Twin reversed arterial perfusion (TRAP) sequence is an extremely rare congenital anomaly in monochorionic (MC) twins. The condition is characterized by a malformed fetus (acardiac twin) without cardiac activities being perfused by a structurally normal one (pump twin) via an artery-to-artery anastomosis in a reverse direction.
CASE SUMMARY
We described the first case of TRAP to receive laser surgery in Vietnam. The 26-wk pregnancy was originally misdiagnosed in another hospital as MC twins with single intrauterine fetal death. Following admission to our center, the diagnosis was amended to a 26-wk TRAP sequence stage IIb. The acardiac twin was 7.5 cm at the longest length, the ratio of the weight of the acardiac twin to the weight of the pump twin was more than 90%, the pump twin showed fetal distress with absent diastolic flow in umbilical artery of pump twin, and the peak systolic velocity in the middle cerebral artery = 1.6 MoM. We performed emergency laser photocoagulation of the acardiac twin’s umbilical cord. After surgery, we successfully maintained the pregnancy for 8 wk and ended it electively by cesarean section at 34 wk of gestation due to rupture of membranes.
CONCLUSION
TRAP should be appropriately diagnosed and treated early to avoid complications of the pump twin. Fetoscopic laser photocoagulation is a new and effective treatment for this condition.
Core Tip: It is an easy mistake to misdiagnose twin reversed arterial perfusion as a single intrauterine fetal death, especially in our case, as the acardiac twin has a head, body, and full limbs. Intrauterine fetal intervention is necessary when the pump twin shows signs of fetal distress. After surgery, the problem of premature rupture of membranes and delivery should be noted. The indication to terminate the pregnancy depends on the mother’s condition, fetal condition, and the acardiac twin’s longest size.
