High‐intensity focused ultrasound treatment for twin reversed arterial perfusion sequence

Twin reversed arterial perfusion (TRAP) sequence is a serious complication of monochorionic twin pregnancies, in which arterioarterial anastomoses allow blood flow from a ‘pump’ fetus to an acardiac fetus via reversed flow in the latter's umbilical artery. Several trial treatments for TRAP sequ...

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Bibliographic Details
Published in:Ultrasound in obstetrics & gynecology 2012-10, Vol.40 (4), p.476-478
Main Authors: Ichizuka, K., Hasegawa, J., Nakamura, M., Matsuoka, R., Sekizawa, A., Okai, T., Umemura, S.
Format: Article
Language:English
Subjects:
Biological and medical sciences
Cesarean Section
Female
Fetal Death
fetal therapy
Fetofetal Transfusion - diagnostic imaging
Fetofetal Transfusion - pathology
Fetofetal Transfusion - therapy
Gynecology. Andrology. Obstetrics
HIFU
High-Intensity Focused Ultrasound Ablation
high‐intensity focused ultrasound
Humans
Infant, Newborn
Medical sciences
non‐invasive
Polyhydramnios - diagnostic imaging
Polyhydramnios - pathology
Pregnancy
Pregnancy Outcome
Pregnancy Trimester, First
Pregnancy, Twin
Premature Birth
Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)
TRAP sequence
Twins
Ultrasonography, Prenatal
Umbilical Arteries - diagnostic imaging
Umbilical Arteries - pathology
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Summary:Twin reversed arterial perfusion (TRAP) sequence is a serious complication of monochorionic twin pregnancies, in which arterioarterial anastomoses allow blood flow from a ‘pump’ fetus to an acardiac fetus via reversed flow in the latter's umbilical artery. Several trial treatments for TRAP sequence have been reported, but all of these have been invasive. We present a case of TRAP sequence in which high‐intensity focused ultrasound (HIFU) was applied to the umbilical artery of the anomalous twin at 26 weeks as a non‐invasive fetal therapy. The HIFU intensity was set at approximately 2300 W/cm2 with exposure periods of 10 s. Color Doppler ultrasound showed a decrease in blood supply to the anomalous twin, although complete occlusion of the targeted vessel was not achieved. Delivery was by Cesarean section at 29 weeks' gestation and the pump twin survived, without severe clinical complications at 6 months. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.
ISSN:0960-7692
1469-0705
DOI:10.1002/uog.11114