Journal List > Korean J Obstet Gynecol > v.53(5) > 1006419

Korean J Obstet Gynecol. 2010 May;53(5):449-454. Korean.
Published online May 31, 2010.
Copyright © 2010 Korean Society of Obstetrics and Gynecology
A case of acardiac twin pregnancy with fetus survival after successful radiofrequency ablation of umbilical cord
Ji hyon Jang, M.D., Myoung Jin Moon, M.D., Hea Ree Park, M.D., Eun Hee Ahn, M.D., Sang Hee Jung, M.D., Yu mi Lee, M.D. and Eun A Kim, M.D.
Department of Obstetrics and Gynecology, CHA University, Bundang Cha Women's Hospital, Seoul, Korea.

Corresponding author (Email: )
Received April 01, 2010; Accepted April 26, 2010.


Acardiac twin is a rare anomaly that occurs 1% in monochorionic twins and 1 in 35,000 pregnancies overall. Acardiac twin, also known as twin-reversed arterial perfusion (TRAP) sequence, involves a "pump" or donor twin perfusing a recipient or "acardiac" twin through vascular (usually arterial-arterial and venous-venous) anastomoses. Perinatal mortality rate for the pump twin has been reported to be 50~75%, mainly as a result of polyhydramnios, preterm labor, and congestive heart failure. Therefore, occlusion of the circulation to the acardiac twin has been recommended to improve perinatal outcome of the pump twin. Radiofrequency ablation of the acardiac twin effectively protects the pump twin from high-output cardiac failure and death. We report our experience in the treatment of patients with TRAP sequence using radio frequency ablation to stop perfusion to the acardiac twin.

Keywords: Radiofrequency ablation; Monochorionic twin; Twin-reversed arterial perfusion (TRAP); Acardiac twin


Fig. 1
(A) cord insertion site: doppler ultrasound image of cord insertion site at the anterior abdominal wall of the acardiac fetus. (B) the tissue effects of radiofrequency ablation (RFA): transabdominal intraoperative ultrasound image reveals the RFA device, deployed within the abdomen of the acardiac fetus, and the echogenic material, which represents the tissue effects of RFA.
Click for larger image

Fig. 2
The acardiac twin and monochorionic diamniotic placenta. It shows the umbilical cord of the acardiac twin contains two vessels, one vein and one artery.
Click for larger image

1. Napolitani FD, Schreiber I. The acardiac monster. A review of the world literature and presentation of 2 cases. Am J Obstet Gynecol 1960;80:582–589.
2. al-Malt A, Ashmead G, Judge N, Mann L, Ashmead J, Stepanchak W. Color-flow and Doppler velocimetry in prenatal diagnosis of acardiac triplet. J Ultrasound Med 1991;10:341–345.
3. Sepulveda W, Bower S, Hassan J, Fisk NM. Ablation of acardiac twin by alcohol injection into the intra-abdominal umbilical artery. Obstet Gynecol 1995;86:680–681.
4. Sogaard K, Skibsted L, Brocks V. Acardiac twins: pathophysiology, diagnosis, outcome and treatment. Six cases and review of the literature. Fetal Diagn Ther 1999;14:53–59.
5. Sullivan AE, Varner MW, Ball RH, Jackson M, Silver RM. The management of acardiac twins: a conservative approach. Am J Obstet Gynecol 2003;189:1310–1313.
6. Diehl W, Hecher K. Selective cord coagulation in acardiac twins. Semin Fetal Neonatal Med 2007;12:458–463.
7. Pretorius DH, Leopold GR, Moore TR, Benirschke K, Sivo JJ. Acardiac twin. Report of Doppler sonography. J Ultrasound Med 1988;7:413–416.
8. Healey MG. Acardia: predictive risk factors for the co-twin's survival. Teratology 1994;50:205–213.
9. Quintero RA, Reich H, Puder KS, Bardicef M, Evans MI, Cotton DB, et al. Brief report: umbilical-cord ligation of an acardiac twin by fetoscopy at 19 weeks of gestation. N Engl JMed 1994;330:469–471.
10. McCurdy CM Jr, Childers JM, Seeds JW. Ligation of the umbilical cord of an acardiac-acephalus twin with an endoscopic intrauterine technique. Obstet Gynecol 1993;82:708–711.
11. Quintero RA, Romero R, Reich H, Goncalves L, Johnson MP, Carreno C, et al. In utero percutaneous umbilical cord ligation in the management of complicated monochorionic multiple gestations. Ultrasound Obstet Gynecol 1996;8:16–22.
12. Ville Y, Hyett JA, Vandenbussche FP, Nicolaides KH. Endoscopic lasercoagulation of umbilical cord vessels in twin reversed arterial perfusion sequence. Ultrasound Obstet Gynecol 1994;4:396–398.
13. Hecher K, Hackeloer BJ, Ville Y. Umbilical cord coagulation by operative microendoscopy at 16 weeks' gestation in an acardiac twin. Ultrasound Obstet Gynecol 1997;10:130–132.
14. Arias F, Sunderji S, Gimpelson R, Colton E. Treatment of acardiac twinning. Obstet Gynecol 1998;91:818–821.
15. Porreco RP, Barton SM, Haverkamp AD. Occlusion of umbilical artery in acardiac, acephalic twin. Lancet 1991;337:326–327.
16. Si Won Lee;Sun Ok Lee;Mi Hye Park;Young Ju Kim;Sun Hee Chun,Jung Ja Ahn.Successful Management with Intra-abdominal Alcohol Ablation of Acardiac Twin and Amniodrainage in Twin Reversed Arterial Perfusion Sequence with Severe Polyhydramnios. Kor J obstet Gynecol 2004;47:1394–1399.
17. Lee H, Wagner AJ, Sy E, Ball R, Feldstein VA, Goldstein RB, et al. Efficacy of radiofrequency ablation for twin-reversed arterial perfusion sequence. Am J Obstet Gynecol 2007;196:459. e1–459. e4.
18. Tsao K, Feldstein VA, Albanese CT, Sandberg PL, Lee H, Harrison MR, et al. Selective reduction of acardiac twin by radiofrequency ablation. Am J Obstet Gynecol 2002;187:635–640.
19. Bilchik AJ, Wood TF, Allegra DP. Radiofrequency ablation of unresectable hepatic malignancies: lessons learned. Oncologist 2001;6:24–33.