Efficacy of radiofrequency ablation for twin-reversed arterial perfusion sequence

Hanmin Lee, Amy J. Wagner, Edgar Sy, Robert Ball, Vickie A. Feldstein, Ruth B. Goldstein, Diana L Farmer

Research output: Contribution to journalArticle

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Abstract

Objective: We report our experience in the treatment of patients with twin-reversed arterial perfusion (TRAP) sequence using radiofrequency ablation to stop perfusion to the acardiac twin and protect the pump twin. Study Design: An IRB approved retrospective review of all patients (n = 29) who underwent percutaneous radiofrequency ablation of an acardiac twin, using ultrasound guidance and either a 14 or 17 gauge radiofrequency needle for twin-reversed arterial perfusion sequence, from 1998 to 2005, was performed by review of hospital and outpatient medical records. Results: The outcomes of all 29 of the patients treated with radiofrequency ablation are known. Twenty-six of the patients had monochorionic-diamniotic pregnancies, whereas 2 had monochorionic-monoamniotic pregnancies. One patient had a triplet pregnancy with a monochorionic-diamniotic pair with TRAP sequence. Overall, 25 of 29 pump twins survived (86%), delivering at a mean gestational age of 34.6 weeks. Survival was 24 of 26 (92%) in monochorionic-diamniotic pregnancies with a mean gestational age of 35.6 weeks. Two women in our early experience sustained thermal injuries from the site of grounding pads. Conclusion: Radiofrequency ablation of the acardiac twin effectively protects the pump twin from high-output cardiac failure and death. Greater than 90% survival can be achieved in monochorionic-diamniotic pregnancies complicated by TRAP sequence with a mean gestation age at time of delivery close to term. Our limited experience in cases of monochorionic-monoamniotic TRAP sequence does not allow the determination of efficacy in this group.

Original languageEnglish (US)
JournalAmerican Journal of Obstetrics and Gynecology
Volume196
Issue number5
DOIs
StatePublished - May 2007

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Perfusion
Pregnancy
Gestational Age
Triplet Pregnancy
Twin Pregnancy
Survival
Research Ethics Committees
Needles
Medical Records
Outpatients
Heart Failure
Hot Temperature
Wounds and Injuries

Keywords

  • acardiac
  • monochorionic-diamniotic pregnancy
  • radiofrequency ablation
  • TRAP sequence

ASJC Scopus subject areas

  • Medicine(all)
  • Obstetrics and Gynecology

Cite this

Efficacy of radiofrequency ablation for twin-reversed arterial perfusion sequence. / Lee, Hanmin; Wagner, Amy J.; Sy, Edgar; Ball, Robert; Feldstein, Vickie A.; Goldstein, Ruth B.; Farmer, Diana L.

In: American Journal of Obstetrics and Gynecology, Vol. 196, No. 5, 05.2007.

Research output: Contribution to journalArticle

Lee, Hanmin ; Wagner, Amy J. ; Sy, Edgar ; Ball, Robert ; Feldstein, Vickie A. ; Goldstein, Ruth B. ; Farmer, Diana L. / Efficacy of radiofrequency ablation for twin-reversed arterial perfusion sequence. In: American Journal of Obstetrics and Gynecology. 2007 ; Vol. 196, No. 5.
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abstract = "Objective: We report our experience in the treatment of patients with twin-reversed arterial perfusion (TRAP) sequence using radiofrequency ablation to stop perfusion to the acardiac twin and protect the pump twin. Study Design: An IRB approved retrospective review of all patients (n = 29) who underwent percutaneous radiofrequency ablation of an acardiac twin, using ultrasound guidance and either a 14 or 17 gauge radiofrequency needle for twin-reversed arterial perfusion sequence, from 1998 to 2005, was performed by review of hospital and outpatient medical records. Results: The outcomes of all 29 of the patients treated with radiofrequency ablation are known. Twenty-six of the patients had monochorionic-diamniotic pregnancies, whereas 2 had monochorionic-monoamniotic pregnancies. One patient had a triplet pregnancy with a monochorionic-diamniotic pair with TRAP sequence. Overall, 25 of 29 pump twins survived (86{\%}), delivering at a mean gestational age of 34.6 weeks. Survival was 24 of 26 (92{\%}) in monochorionic-diamniotic pregnancies with a mean gestational age of 35.6 weeks. Two women in our early experience sustained thermal injuries from the site of grounding pads. Conclusion: Radiofrequency ablation of the acardiac twin effectively protects the pump twin from high-output cardiac failure and death. Greater than 90{\%} survival can be achieved in monochorionic-diamniotic pregnancies complicated by TRAP sequence with a mean gestation age at time of delivery close to term. Our limited experience in cases of monochorionic-monoamniotic TRAP sequence does not allow the determination of efficacy in this group.",
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