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Twin-reversed arterial perfusion sequence

MedGen UID:
1842726
•Concept ID:
C5575500
•
Disease or Syndrome
Synonyms: ; TRAP
 
Monarch Initiative: MONDO:0850014
Orphanet: ORPHA617297

Definition

A rare disorder related to monochorionic twin pregnancy characterized by complete or partial absence of cardiac development in one twin (''''acardiac twin'''') and blood supply of both circulations by the morphologically normal co-twin (''''pump twin'''') via an arterioarterial anastomosis. In most cases, the acardiac twin has well developed legs and pelvis but no cephalic pole, thoracic organs, and upper extremities. The condition is associated with a high risk of perinatal death of the pump twin due to a combination of high-output cardiac failure and polyhydramnios-related pre-term birth. Hypoxia and intrauterine growth restriction are also seen in the pump twin. [from ORPHANET]

Professional guidelines

PubMed

Management of Complicated Monochorionic Twin Gestations: An Evidence-Based Protocol.
Narang K, Novoa VAN, Alrahmani L, Parikh P, Codsi E, Rose CH, Davies NP, Trinidad MC, Favre R, Szymanski LM, Ruano R
Obstet Gynecol Surv 2021 Sep;76(9):541-549. doi: 10.1097/OGX.0000000000000917. PMID: 34586420
Diagnosis and Management of Complicated Monochorionic Twins.
Moldenhauer JS, Johnson MP
Clin Obstet Gynecol 2015 Sep;58(3):632-42. doi: 10.1097/GRF.0000000000000127. PMID: 26176787
Intrafetal laser treatment for twin reversed arterial perfusion sequence: cohort study and meta-analysis.
Pagani G, D'Antonio F, Khalil A, Papageorghiou A, Bhide A, Thilaganathan B
Ultrasound Obstet Gynecol 2013 Jul;42(1):6-14. doi: 10.1002/uog.12495. PMID: 23640771

Recent clinical studies

Etiology

Monochorionic monoamniotic twin pregnancies.
Van Mieghem T, Abbasi N, Shinar S, Keunen J, Seaward G, Windrim R, Ryan G
Am J Obstet Gynecol MFM 2022 Mar;4(2S):100520. Epub 2021 Oct 30 doi: 10.1016/j.ajogmf.2021.100520. PMID: 34728404
Placental Anatomy and Function in Twin Gestations.
Shanahan MA, Bebbington MW
Obstet Gynecol Clin North Am 2020 Mar;47(1):99-116. doi: 10.1016/j.ogc.2019.10.010. PMID: 32008674
First-trimester intervention in twin reversed arterial perfusion sequence.
Tavares de Sousa M, Glosemeyer P, Diemert A, Bamberg C, Hecher K
Ultrasound Obstet Gynecol 2020 Jan;55(1):47-49. Epub 2019 Dec 12 doi: 10.1002/uog.20860. PMID: 31486133
Diagnosis and Management of Complicated Monochorionic Twins.
Moldenhauer JS, Johnson MP
Clin Obstet Gynecol 2015 Sep;58(3):632-42. doi: 10.1097/GRF.0000000000000127. PMID: 26176787
Twin-reversed arterial perfusion sequence associated with decreased fetal cerebral vascular impedance.
Peyvandi S, Feldstein VA, Hirose S, Rand L, Brook MM, Moon-Grady AJ
Ultrasound Obstet Gynecol 2015 Apr;45(4):447-51. doi: 10.1002/uog.14650. PMID: 25157457Free PMC Article

Diagnosis

Monochorionic monoamniotic twin pregnancies.
Van Mieghem T, Abbasi N, Shinar S, Keunen J, Seaward G, Windrim R, Ryan G
Am J Obstet Gynecol MFM 2022 Mar;4(2S):100520. Epub 2021 Oct 30 doi: 10.1016/j.ajogmf.2021.100520. PMID: 34728404
Placental Anatomy and Function in Twin Gestations.
Shanahan MA, Bebbington MW
Obstet Gynecol Clin North Am 2020 Mar;47(1):99-116. doi: 10.1016/j.ogc.2019.10.010. PMID: 32008674
Diagnosis and Management of Complicated Monochorionic Twins.
Moldenhauer JS, Johnson MP
Clin Obstet Gynecol 2015 Sep;58(3):632-42. doi: 10.1097/GRF.0000000000000127. PMID: 26176787
Twin-reversed arterial perfusion sequence associated with decreased fetal cerebral vascular impedance.
Peyvandi S, Feldstein VA, Hirose S, Rand L, Brook MM, Moon-Grady AJ
Ultrasound Obstet Gynecol 2015 Apr;45(4):447-51. doi: 10.1002/uog.14650. PMID: 25157457Free PMC Article
Fetoscopy.
Yang EY, Adzick NS
Semin Laparosc Surg 1998 Mar;5(1):31-9. doi: 10.1177/155335069800500107. PMID: 9516558

Therapy

First-trimester intervention in twin reversed arterial perfusion sequence.
Tavares de Sousa M, Glosemeyer P, Diemert A, Bamberg C, Hecher K
Ultrasound Obstet Gynecol 2020 Jan;55(1):47-49. Epub 2019 Dec 12 doi: 10.1002/uog.20860. PMID: 31486133
Error traps in fetal surgery.
Peiro JL, Crombleholme TM
Semin Pediatr Surg 2019 Jun;28(3):143-150. Epub 2019 Apr 25 doi: 10.1053/j.sempedsurg.2019.04.012. PMID: 31171149
Outcome of twin reversed arterial perfusion sequence following treatment with interstitial laser: a retrospective study.
Scheier M, Molina FS
Fetal Diagn Ther 2012;31(1):35-41. Epub 2011 Dec 23 doi: 10.1159/000334156. PMID: 22204966
Specific complications of monochorionic twin pregnancies: twin-twin transfusion syndrome and twin reversed arterial perfusion sequence.
Chalouhi GE, Stirnemann JJ, Salomon LJ, Essaoui M, Quibel T, Ville Y
Semin Fetal Neonatal Med 2010 Dec;15(6):349-56. Epub 2010 Sep 19 doi: 10.1016/j.siny.2010.09.003. PMID: 20855238
Fetal therapy.
Nicolaides K, Pettersen H
Curr Opin Obstet Gynecol 1994 Oct;6(5):468-71. PMID: 7827279

Prognosis

Outcome of Monochorionic Monoamniotic Twin Reversed Arterial Perfusion Sequence Diagnosed in the First Trimester.
Weber EC, Recker F, Gottschalk I, Strizek B, Geipel A, Gembruch U, Berg C
Fetal Diagn Ther 2021;48(11-12):778-784. Epub 2021 Dec 13 doi: 10.1159/000519860. PMID: 34903686
First-trimester intervention in twin reversed arterial perfusion sequence: does size matter?
Roethlisberger M, Strizek B, Gottschalk I, Mallmann MR, Geipel A, Gembruch U, Berg C
Ultrasound Obstet Gynecol 2017 Jul;50(1):40-44. doi: 10.1002/uog.16013. PMID: 27390925
Twin-reversed arterial perfusion sequence associated with decreased fetal cerebral vascular impedance.
Peyvandi S, Feldstein VA, Hirose S, Rand L, Brook MM, Moon-Grady AJ
Ultrasound Obstet Gynecol 2015 Apr;45(4):447-51. doi: 10.1002/uog.14650. PMID: 25157457Free PMC Article
Intrafetal laser treatment for twin reversed arterial perfusion sequence: cohort study and meta-analysis.
Pagani G, D'Antonio F, Khalil A, Papageorghiou A, Bhide A, Thilaganathan B
Ultrasound Obstet Gynecol 2013 Jul;42(1):6-14. doi: 10.1002/uog.12495. PMID: 23640771
Treatment of acardiac twinning.
Arias F, Sunderji S, Gimpelson R, Colton E
Obstet Gynecol 1998 May;91(5 Pt 2):818-21. doi: 10.1016/s0029-7844(97)00708-4. PMID: 9572174

Clinical prediction guides

First-trimester intervention in twin reversed arterial perfusion sequence: does size matter?
Roethlisberger M, Strizek B, Gottschalk I, Mallmann MR, Geipel A, Gembruch U, Berg C
Ultrasound Obstet Gynecol 2017 Jul;50(1):40-44. doi: 10.1002/uog.16013. PMID: 27390925
The TRAP (twin reversed arterial perfusion) sequence - case presentation.
Mărginean C, Mărginean MO, Mureşan D, Zahiu L, Horváth E
Rom J Morphol Embryol 2016;57(1):259-65. PMID: 27151718
Twin reversed arterial perfusion sequence is more common than generally accepted.
van Gemert MJ, van den Wijngaard JP, Vandenbussche FP
Birth Defects Res A Clin Mol Teratol 2015 Jul;103(7):641-3. Epub 2015 Jul 14 doi: 10.1002/bdra.23405. PMID: 26172962
Echocardiographic risk stratification of fetuses with sacrococcygeal teratoma and twin-reversed arterial perfusion.
Byrne FA, Lee H, Kipps AK, Brook MM, Moon-Grady AJ
Fetal Diagn Ther 2011;30(4):280-8. Epub 2011 Nov 12 doi: 10.1159/000330762. PMID: 22086180
Ultrasound in twin pregnancies.
Morin L, Lim K; DIAGNOSTIC IMAGING COMMITTEE; SPECIAL CONTRIBUTOR; GENETICS COMMITTEE; MATERNAL FETAL MEDICINE COMMITTEE
J Obstet Gynaecol Can 2011 Jun;33(6):643-656. doi: 10.1016/S1701-2163(16)34916-7. PMID: 21846456

Recent systematic reviews

A systematic review of early intrauterine intervention at 12 + 0 to 16 + 6 weeks in twin reversed arterial perfusion sequence.
Ventura W, Sugajara R, Quintana W, Llancarí P, Novoa RH
Eur J Obstet Gynecol Reprod Biol 2024 Apr;295:92-97. Epub 2024 Feb 8 doi: 10.1016/j.ejogrb.2024.02.001. PMID: 38342009
Fetal surgery in complicated monoamniotic pregnancies: case series and systematic review of the literature.
Peeters SH, Devlieger R, Middeldorp JM, DeKoninck P, Deprest J, Lopriore E, Lewi L, Klumper FJ, Kontopoulos E, Quintero R, Oepkes D
Prenat Diagn 2014 Jun;34(6):586-91. Epub 2014 Mar 19 doi: 10.1002/pd.4353. PMID: 24596242
Impact of cord entanglement on perinatal outcome of monoamniotic twins: a systematic review of the literature.
Rossi AC, Prefumo F
Ultrasound Obstet Gynecol 2013 Feb;41(2):131-5. doi: 10.1002/uog.12345. PMID: 23371346

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