Selective reduction of acardiac twin by radiofrequency ablation

KuoJen Tsao, Vickie A. Feldstein, Craig T. Albanese, Per L. Sandberg, Hanmin Lee, Michael R. Harrison, Diana L Farmer

Research output: Contribution to journalArticle

117 Citations (Scopus)

Abstract

OBJECTIVE: Acardiac/acephalic twinning is a rare anomaly in which a normal "pump" twin perfuses an acardiac twin, which results in twin reversed arterial perfusion sequence. A novel technique for selective reduction and obliteration of blood flow in the acardiac twin is described. STUDY DESIGN: Thirteen consecutive cases of monochorionic twin gestation with twin reversed arterial perfusion sequence underwent selective reduction of the abnormal twin with the use of radiofrequency ablation. Under direct real-time sonographic guidance, a 3-mm (14-gauge) radiofrequency ablation needle was percutaneously inserted through the maternal abdominal wall into the intrauterine fetal abdomen at the level of the cord insertion site of the acardiac twin. Energy was applied until termination of blood flow to the acardiac fetus was documented by Doppler ultrasound scanning. RESULTS: All 13 mothers tolerated the procedure without major complications. All 13 "pump" fetuses have been delivered. Twelve of 13 infants are alive and well. The first patient in this series was delivered at 24.4 weeks and the infant subsequently died from complications of prematurity. Average gestational age at intervention was 20.7 weeks, and the average gestational age at delivery was 36.2 weeks. CONCLUSION: Radiofrequency ablation is a minimally invasive, percutaneous technique that can effectively obliterate blood supply to an acardiac twin to preserve and protect the pump twin.

Original languageEnglish (US)
Pages (from-to)635-640
Number of pages6
JournalAmerican Journal of Obstetrics and Gynecology
Volume187
Issue number3
DOIs
StatePublished - Sep 2002

Fingerprint

Gestational Age
Fetus
Perfusion
Mothers
Doppler Ultrasonography
Abdominal Wall
Abdomen
Needles
Pregnancy

Keywords

  • Acardiac
  • Radiofrequency ablation
  • TRAP sequence

ASJC Scopus subject areas

  • Medicine(all)
  • Obstetrics and Gynecology

Cite this

Tsao, K., Feldstein, V. A., Albanese, C. T., Sandberg, P. L., Lee, H., Harrison, M. R., & Farmer, D. L. (2002). Selective reduction of acardiac twin by radiofrequency ablation. American Journal of Obstetrics and Gynecology, 187(3), 635-640. https://doi.org/10.1067/mob.2002.125242

Selective reduction of acardiac twin by radiofrequency ablation. / Tsao, KuoJen; Feldstein, Vickie A.; Albanese, Craig T.; Sandberg, Per L.; Lee, Hanmin; Harrison, Michael R.; Farmer, Diana L.

In: American Journal of Obstetrics and Gynecology, Vol. 187, No. 3, 09.2002, p. 635-640.

Research output: Contribution to journalArticle

Tsao, K, Feldstein, VA, Albanese, CT, Sandberg, PL, Lee, H, Harrison, MR & Farmer, DL 2002, 'Selective reduction of acardiac twin by radiofrequency ablation', American Journal of Obstetrics and Gynecology, vol. 187, no. 3, pp. 635-640. https://doi.org/10.1067/mob.2002.125242
Tsao K, Feldstein VA, Albanese CT, Sandberg PL, Lee H, Harrison MR et al. Selective reduction of acardiac twin by radiofrequency ablation. American Journal of Obstetrics and Gynecology. 2002 Sep;187(3):635-640. https://doi.org/10.1067/mob.2002.125242
Tsao, KuoJen ; Feldstein, Vickie A. ; Albanese, Craig T. ; Sandberg, Per L. ; Lee, Hanmin ; Harrison, Michael R. ; Farmer, Diana L. / Selective reduction of acardiac twin by radiofrequency ablation. In: American Journal of Obstetrics and Gynecology. 2002 ; Vol. 187, No. 3. pp. 635-640.
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