Indian Journal of Radiology and Imaging Indian Journal of Radiology and Imaging

OBSTETRIC IMAGING
Year
: 2003  |  Volume : 13  |  Issue : 4  |  Page : 421--422

A case of acardiac twinning


HB Suresh, PK John 
 Department of Radiodiagnosis, Fr Muller Medical College, Mangalore, India

Correspondence Address:
H B Suresh
Department of Radiodiagnosis, Fr Muller Medical College, Mangalore
India




How to cite this article:
Suresh H B, John P K. A case of acardiac twinning.Indian J Radiol Imaging 2003;13:421-422


How to cite this URL:
Suresh H B, John P K. A case of acardiac twinning. Indian J Radiol Imaging [serial online] 2003 [cited 2019 Nov 14 ];13:421-422
Available from: http://www.ijri.org/text.asp?2003/13/4/421/28725


Full Text

 Introduction

:

Acardiac twinning is an extreme manifestation of twin transfusion syndrome. The acardiac twin presents with many bizarre anomalies which is thought to be due to low oxygen tension and alterations in foetal physiology .We present a case of which was diagnosed at 26 weeks of gestation.

 Case Report



A 20 year old primigravida patient came with history of abdominal pain to the obstetrician. She was of 26 weeks gestational age. The patient was referred for US examination. This revealed a live foetus of 26 weeks gestational age.This foetus did not reveal any detectable anomalies.

There was another foetus in the same amniotic cavity which had absence of thorax,head and upper limbs. There was only a foetal abdomen and lower limbs which appeared oedematous. There was a single placenta which appeared to be supplying both foetii [Figure 1],[Figure 2],[Figure 3],[Figure 4]..

The patient was admitted and advised rest.On the sixth day a repeat US was performed which showed similar findings. She developed labour pains the following day and she delivered a baby with a gestational maturing date of around 27 weeks.The baby developed respiratory distress and expired 17 hours after birth. The acardiac twin was delivered 15 minutes after the normal twin. The findings detected antenatally were corroborated. [Figure 5]. A plain radiograph showed lower three lumbar vertebrae and lower limb bones [Figure 6]

 Discussion



Acardiac twinning is also referred to as twin reversed arterial perfusion(TRAP) sequence. It has an incidence of 1 in 35000 pregnancies This suggests vascular disruption as an etiology rather than a primary cardiac defect[1].

It is the most severe complication in monozygotic Twinning[2].It is categorized as being of four types according to the site of maldevelopment.

(a) Acardius anceps : has a body and extremities with only a partially formed head and face.

(b) Acardiius acephalus: has a well developed pelvis and lower limbs without a head,thoracic organs or arms. The twin born in our hospital is of this category .

(c) Acardius amorphous: is a shapeless mass of tissue with no recognizable organs,but some form of axial structures.

(d) Acardius acormus: has only cranial development[3]

There is a reported incidence of preterm labour in 79% of pregnancies, Polyhydramnios in 51 %,Congestive heart failure in 28% and pump foetal death in utero in 25%.There is an incidence of single umbilical artery and most cases show artery to artery and vein to vein anastomosis[4].The inadequate pump pressure leads to decreased oxygenated blood flow to this foetus with disruption and reduction of existing structures. Doppler study shows an elevated S/ D ratio due to the reversed flow in the acardiac twin umbilical artery [5].There is a higher incidence of other anomalies in the pump twin.

Active intervention with endoscopic laser ablation has shown varying degrees of success in various cases[6]

References

1Healy MG, Acardia: Predictive risk factors for the co-twin's survival.Am J Med Genet 1991;Jun 15:39(4):453-7
2Morizane M,Ohara N, Mori T, Murao S,Neuropathological features of the brain in acardius acormus. Early pregnancy 2000;Oct 4 (4):261-70
3Mohanty C, Mishra OP, Singh CP, Das BK, Singla PN, Acardiac anomaly spectrum. Obstet Gynecol 1998; May 91;818-21
4Sen S, Esen UI, Sturgiss SN, Twin reversed arterial perfusion syndrome. J Perinat Med 2002; 30(3);267-72
5Sherer DM, Armstrong B, Shah Y et al, Prenatal sonographic Diagnosis, Doppler velocimetric umbilical cord studies, and subsequent management of an acardiac twin pregnancy.Obstet Gynecol 74:472-475,1989
6Arias F, Sunderji S, Gimpelson R,Colton E, Treatment of acardiac Twinning.Clin Dysmorphol 1997;Oct 6(4):359-63