Donald School Journal of Ultrasound in Obstetrics and Gynecology

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VOLUME 5 , ISSUE 3 ( July-September, 2011 ) > List of Articles


Advances in Ultrasonic Assessment of Acardiac Twin

Florin Stamatian, Daniel Muresan, Gabriela Caracostea, Tunde Kovacs

Keywords : Acardiac,Pump twin,TRAP,Monochorionic

Citation Information : Stamatian F, Muresan D, Caracostea G, Kovacs T. Advances in Ultrasonic Assessment of Acardiac Twin. Donald School J Ultrasound Obstet Gynecol 2011; 5 (3):213-218.

DOI: 10.5005/jp-journals-10009-1198

License: CC BY-NC 4.0

Published Online: 01-03-2012

Copyright Statement:  Copyright © 2011; The Author(s).


The development of an acardiac anomaly, one of the most severe human malformations, is a rare complication unique to monochorionic multiple pregnancies. In this condition, the primary malformation is the lack of a well-defined cardiac structure in one twin (the acardiac twin), which is kept alive by its structurally normal co-twin (the pump twin).

The final diagnosis for a twin pregnancy with an acardiac twin may be established after the 9th week, when the cephalic extremity and limbs can be precisely determined.

Direct signs that lead to the diagnosis of an acardiac twin include the absence of cardiac and fetal movements, difficult visualization of the trunk and cephalic poles, thickening of subcutaneous tissue and the presence of umbilical artery reverse flow towards the acardiac fetus mass. The pump fetus may demonstrate hydramnios, cardiomegaly and heart failure.

Once an acardiac anomaly is diagnosed, both the acardiac and pump twins should be assessed to classify the pregnancy according to prognostic factors based on the size and growth of the acardiac twin and the cardiovascular condition of the pump twin. Assessing the extent of heart damage in the pump fetus is a key step in pregnancy management.

There are two available options, either conservative or interventional, for the management of these pregnancies. Serial ultrasound surveillance is important for detecting any worsening of the condition, which may suggest the need for interventions to optimize the pump-twin's chance for survival.

We performed a retrospective analysis of three cases of monochorionic twin pregnancies diagnosed with a twin reversed arterial perfusion (TRAP) sequence during the first and second trimesters. We compared our data with those offered by a review of the literature.

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  1. Acardiac headless twin: A case report and review of the literature. Archives de Pediatrie 2010;17:253-57.
  2. Specific complications of monochorionic twin pregnancies: Twin-twin transfusion syndrome and twin reversed arterial perfusion sequence. Semin Fetal Neonatal Med Dec 2010;15(6):349-56; Epub 2010 Sep 19.
  3. Acardiac fetus in a triplet pregnancy: Ultrasound pitfalls–a case report. Eur J Obstet Gynecol Reprod Biol Mar 2000;89(1):75-80.
  4. The acardiac twin: A case report. J Reprod Med 1988;33:320.
  5. Acardiac twin pregnancy: Associated with trisomy 2–case report. Oxford Journals, Oct 1999;15:474-75.
  6. Complicated monochorionic twin pregnancies. Updates in Fetal Diagnosis and Treatment Clinics in Perinatology Jun 2009;36(2):417-30.
  7. Acardiac anomaly: Current issues in prenatal assessment and treatment. Prenatal Diagn 2005;25: 796-806.
  8. Twin-twin transfusion syndrome: The challenge of etiology-based management decisions. Current Opinion in Obstetrics and Gynecology Dec 1998;10(6):441-46.
  9. The influence of twinning on cardiac development. Early Hum Dev Mar 2008;84(3):173-79. Epub 2008 Feb 21.
  10. Twin reversed arterial perfusion (TRAP) sequence: A study of 14 twin pregnancies with acardius. Semin Perinatol Oct 1983;7(4):285-93.
  11. Acardiac amorphous twin with Prune Belly sequence in the co-twin. Am J Med Genet 1991;39:453-57.
  12. Malformations in acardiac twins are consistent with reversed blood flow: Liver as a clue to their pathogenesis. Pediatr Dev Pathology 2003;6:520-30.
  13. Umbilical cord complications 2009.
  14. Obstetrics, gynaecology and reproductive medicine. October 2007;17:289-95.
  15. When does death occur in an acardiac twin? Ultrasound diagnostic difficulties. J Perinat Med 1990;18:223-27.
  16. Placental pathology in TRAP sequence: Clinical and pathogenetic implications. Fetal Pediatr Pathol 2008;27(1):13-29.
  17. The acardiac anomaly. Teratology 1977;15:311-16.
  18. Holoacardius anceps with abnormal karyotype and multicystic renal dysplasia with patent ductus arteriosus in a surviving co-twin (abstract). Mod Pathol 1990;3:10P.
  19. An acephalus acardius amorphous fetus in a monochorionic pregnancy with sex discrepancy. Twin Res Hum Genetics 2006;9:697-702.
  20. Twin reverse arterilal perfusion sequence. In Blickstein I, Keith LG. Multiple pregnancy. Epidemiology, gestation and perinatlal outcome (2nd ed). Informa Healthcare, 594-600.
  21. The management of acardiac twins: A conservative approach. Am J Obstet Gynecol Nov 2003;189(5):1310-13.
  22. TRAP sequence–successful out-teriorization come with indomethacin treatment. Obstet Gynecol 1990;76:960-62.
  23. The intrauterine treatment of foetal cardiac failure in a twin pregnancy with an acardiac, acephalic monster. Am J Obstet Gynecol Dec 1, 1983;147(7):842-44.
  24. In utero percutaneous umbilical cord ligation in the management of complicated monochorionic multiple gestation. Ultrasound Obstet Gynecol 1996;8:16-22.
  25. Acardiac twin: A systemtic review of minimally invasive treatment modalities. Ultrasound Obstet Gynecol 2003;22:409-19.
  26. Twin, acardiac, ultrasound-guided embolization. Fetus 1991;1(3):5-10.
  27. Umbilical-cord ligation of an acardiac twin by fetoscopy at 19 weeks of gestation. N Engl J Med 1994;330:469-71.
  28. Perinatal outcome of forty nine pregnancies complicated by acardiac twinning. Am J Obstet Gynecol 1990;63:907-12.
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