Management of twin reversed arterial perfusion sequence: eight cases over 13 years.

IF 1.5 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL
Annals of Saudi Medicine Pub Date : 2023-07-01 Epub Date: 2023-08-03 DOI:10.5144/0256-4947.2023.199
Saud Alshanafey, Maha Al-Nemer, Maha Tulbah, Rubina Ma Khan, Nada Al Sahan, Maisoon Al Mugbel, Fahad Al-Hazzani, Gawaher Almutairi, Wesam Kurdi
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引用次数: 0

Abstract

Background: Twin reversed arterial perfusion (TRAP) sequence is a rare condition that affects primarily monozygotic monochorionic twin pregnancies in which a normal twin acts as a pump (donor) for an acardiac recipient (perfuse) twin.

Objective: We report our experience over the last 13 years at a tertiary health care center.

Design: Descriptive, retrospective case series SETTING: Tertiary health care center PATIENTS AND METHODS: All TRAP cases managed between the years 2009 and 2022 at our Fetal Diagnosis and Therapy Center were included. Data recorded included demographic and clinical information which was used to generate descriptive data. Patients were managed by a multidisciplinary team with variable interventions.

Main outcome measure: Survival of normal twin SAMPLE SIZE: Eight RESULTS: Eight pregnant women with TRAP syndrome were managed at our center during that period. One was monozygotic monochorionic and the others were monochorionic diamniotic. Median maternal age at presentation was 27 years and median gestational age at diagnosis was 23 weeks. All were diagnosed with ultrasound (US) imaging. Three were managed with bipolar ligation of the cord of the acardiac twin under general anesthesia, one US-guided (single port) and 2 fetoscopic (2 ports) with a median operative time of 39 minutes. The last five cases were managed with US-guided radiofrequency ablation (RFA) under local anesthesia, one needed 2 sessions, 1 week apart. The median duration of the RFA procedure was 23 minutes. There were no complications and all had viable normal babies born at a median of 32 weeks of gestation (6 C-section, 2 spontaneous membrane rupture).

Conclusions: Acardiac twin cord ligation and RFA are feasible and safe options with excellent outcome for TRAP syndrome. RFA may be preferable owing to its less invasiveness under local anesthesia.

Limitations: None, given the rarity of the disease and the study design.

Conflict of interest: None.

双反动脉灌注序列的处理:8例13年以上。
背景:双胎反向动脉灌注(TRAP)序列是一种罕见的情况,主要影响单卵单绒毛双胎妊娠,在这种妊娠中,正常的双胎充当阿卡迪亚受体(灌注)双胎的泵(供体)。目的:我们报告过去13年在三级医疗保健中心的工作经历。设计:描述性、回顾性病例系列设置:三级医疗保健中心患者和方法:纳入2009年至2022年在我们的胎儿诊断和治疗中心管理的所有TRAP病例。记录的数据包括用于生成描述性数据的人口统计和临床信息。患者由一个多学科团队进行管理,并采取各种干预措施。主要结果指标:正常双胞胎的存活率样本量:8个结果:在此期间,我们中心对8名患有TRAP综合征的孕妇进行了治疗。一个是单卵单核细胞,另一个是双核细胞。出现时的中位母亲年龄为27岁,诊断时的中位数胎龄为23周。所有患者均经超声(US)成像诊断。其中三例在全身麻醉下对双足脊髓进行双极结扎,一例在US引导下(单端口),2例在胎儿镜下(2端口),中位手术时间为39分钟。最后5例病例在局部麻醉下采用US引导射频消融(RFA)进行治疗,其中1例需要2次治疗,间隔1周。RFA手术的中位持续时间为23分钟。无并发症,所有婴儿均在妊娠中期32周出生(6例剖腹产,2例自发性胎膜破裂)。RFA可能是优选的,因为它在局部麻醉下的侵袭性较小。局限性:考虑到这种疾病的罕见性和研究设计,没有。利益冲突:无。
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来源期刊
Annals of Saudi Medicine
Annals of Saudi Medicine 医学-医学:内科
CiteScore
2.80
自引率
0.00%
发文量
44
审稿时长
4-8 weeks
期刊介绍: The Annals of Saudi Medicine (ASM) is published bimonthly by King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia. We publish scientific reports of clinical interest in English. All submissions are subject to peer review by the editorial board and by reviewers in appropriate specialties. The journal will consider for publication manuscripts from any part of the world, but particularly reports that would be of interest to readers in the Middle East or other parts of Asia and Africa. Please go to the Author Resource Center for additional information.
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