Cargando…

“The Strange Case of Dr Pump and Mr Acardiac”: The Twin Reversed Arterial Perfusion (TRAP) Sequence in Two Monochorionic Monoamniotic (MCMA) Twin Pregnancies—Diagnosis, Prognosis and Management: Review of Literature

The Twin Reversed Arterial Perfusion (TRAP) Sequence is an extremely rare complication of monochorionic twin pregnancies, with one severely malformed twin (the “acardiac”) lacking autonomous placental blood supply and being perfused by the co-twin (the “pump”), through arterio-arterial (and sometime...

Descripción completa

Detalles Bibliográficos
Autores principales: Nicolì, Pierpaolo, Damiani, Gianluca Raffaello, Gaetani, Maria, Dellino, Miriam, Vitagliano, Amerigo, Malvasi, Antonio, Cazzato, Gerardo, Cascardi, Eliano, Marzullo, Andrea, Alfonso, Raffaello, Cicinelli, Ettore, Vimercati, Antonella
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10572342/
https://www.ncbi.nlm.nih.gov/pubmed/37835852
http://dx.doi.org/10.3390/diagnostics13193109
_version_ 1785120212632207360
author Nicolì, Pierpaolo
Damiani, Gianluca Raffaello
Gaetani, Maria
Dellino, Miriam
Vitagliano, Amerigo
Malvasi, Antonio
Cazzato, Gerardo
Cascardi, Eliano
Marzullo, Andrea
Alfonso, Raffaello
Cicinelli, Ettore
Vimercati, Antonella
author_facet Nicolì, Pierpaolo
Damiani, Gianluca Raffaello
Gaetani, Maria
Dellino, Miriam
Vitagliano, Amerigo
Malvasi, Antonio
Cazzato, Gerardo
Cascardi, Eliano
Marzullo, Andrea
Alfonso, Raffaello
Cicinelli, Ettore
Vimercati, Antonella
author_sort Nicolì, Pierpaolo
collection PubMed
description The Twin Reversed Arterial Perfusion (TRAP) Sequence is an extremely rare complication of monochorionic twin pregnancies, with one severely malformed twin (the “acardiac”) lacking autonomous placental blood supply and being perfused by the co-twin (the “pump”), through arterio-arterial (and sometimes also veno-venous) vascular anastomoses located on the placental surface. The prognosis is poor: mortality is 100% in the acardiac twin because of its severe malformations and about 50–55% in the pump twin, mainly due to heart failure and prematurity. So, the goal of perinatal management of the TRAP twin pregnancy is to deliver a healthy and near-term pump twin without heart failure or fetal hydrops. Intuitively, the earlier the diagnosis, the better the outcome. Herein, we report two cases of monochorionic monoamniotic (MCMA) twin pregnancies complicated by the TRAP Sequence, which are of interest since the objective of early diagnosis was achieved by means of transvaginal and 3D ultrasound, two techniques which revealed themselves as being useful to this purpose but are underused in the literature. The second aim of this study is to provide an overview of literature data about the diagnosis, prognosis establishment, and management of this rare condition, which are still debated and unclear due to negligible poor-quality evidence.
format Online
Article
Text
id pubmed-10572342
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-105723422023-10-14 “The Strange Case of Dr Pump and Mr Acardiac”: The Twin Reversed Arterial Perfusion (TRAP) Sequence in Two Monochorionic Monoamniotic (MCMA) Twin Pregnancies—Diagnosis, Prognosis and Management: Review of Literature Nicolì, Pierpaolo Damiani, Gianluca Raffaello Gaetani, Maria Dellino, Miriam Vitagliano, Amerigo Malvasi, Antonio Cazzato, Gerardo Cascardi, Eliano Marzullo, Andrea Alfonso, Raffaello Cicinelli, Ettore Vimercati, Antonella Diagnostics (Basel) Case Report The Twin Reversed Arterial Perfusion (TRAP) Sequence is an extremely rare complication of monochorionic twin pregnancies, with one severely malformed twin (the “acardiac”) lacking autonomous placental blood supply and being perfused by the co-twin (the “pump”), through arterio-arterial (and sometimes also veno-venous) vascular anastomoses located on the placental surface. The prognosis is poor: mortality is 100% in the acardiac twin because of its severe malformations and about 50–55% in the pump twin, mainly due to heart failure and prematurity. So, the goal of perinatal management of the TRAP twin pregnancy is to deliver a healthy and near-term pump twin without heart failure or fetal hydrops. Intuitively, the earlier the diagnosis, the better the outcome. Herein, we report two cases of monochorionic monoamniotic (MCMA) twin pregnancies complicated by the TRAP Sequence, which are of interest since the objective of early diagnosis was achieved by means of transvaginal and 3D ultrasound, two techniques which revealed themselves as being useful to this purpose but are underused in the literature. The second aim of this study is to provide an overview of literature data about the diagnosis, prognosis establishment, and management of this rare condition, which are still debated and unclear due to negligible poor-quality evidence. MDPI 2023-09-30 /pmc/articles/PMC10572342/ /pubmed/37835852 http://dx.doi.org/10.3390/diagnostics13193109 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Case Report
Nicolì, Pierpaolo
Damiani, Gianluca Raffaello
Gaetani, Maria
Dellino, Miriam
Vitagliano, Amerigo
Malvasi, Antonio
Cazzato, Gerardo
Cascardi, Eliano
Marzullo, Andrea
Alfonso, Raffaello
Cicinelli, Ettore
Vimercati, Antonella
“The Strange Case of Dr Pump and Mr Acardiac”: The Twin Reversed Arterial Perfusion (TRAP) Sequence in Two Monochorionic Monoamniotic (MCMA) Twin Pregnancies—Diagnosis, Prognosis and Management: Review of Literature
title “The Strange Case of Dr Pump and Mr Acardiac”: The Twin Reversed Arterial Perfusion (TRAP) Sequence in Two Monochorionic Monoamniotic (MCMA) Twin Pregnancies—Diagnosis, Prognosis and Management: Review of Literature
title_full “The Strange Case of Dr Pump and Mr Acardiac”: The Twin Reversed Arterial Perfusion (TRAP) Sequence in Two Monochorionic Monoamniotic (MCMA) Twin Pregnancies—Diagnosis, Prognosis and Management: Review of Literature
title_fullStr “The Strange Case of Dr Pump and Mr Acardiac”: The Twin Reversed Arterial Perfusion (TRAP) Sequence in Two Monochorionic Monoamniotic (MCMA) Twin Pregnancies—Diagnosis, Prognosis and Management: Review of Literature
title_full_unstemmed “The Strange Case of Dr Pump and Mr Acardiac”: The Twin Reversed Arterial Perfusion (TRAP) Sequence in Two Monochorionic Monoamniotic (MCMA) Twin Pregnancies—Diagnosis, Prognosis and Management: Review of Literature
title_short “The Strange Case of Dr Pump and Mr Acardiac”: The Twin Reversed Arterial Perfusion (TRAP) Sequence in Two Monochorionic Monoamniotic (MCMA) Twin Pregnancies—Diagnosis, Prognosis and Management: Review of Literature
title_sort “the strange case of dr pump and mr acardiac”: the twin reversed arterial perfusion (trap) sequence in two monochorionic monoamniotic (mcma) twin pregnancies—diagnosis, prognosis and management: review of literature
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10572342/
https://www.ncbi.nlm.nih.gov/pubmed/37835852
http://dx.doi.org/10.3390/diagnostics13193109
work_keys_str_mv AT nicolipierpaolo thestrangecaseofdrpumpandmracardiacthetwinreversedarterialperfusiontrapsequenceintwomonochorionicmonoamnioticmcmatwinpregnanciesdiagnosisprognosisandmanagementreviewofliterature
AT damianigianlucaraffaello thestrangecaseofdrpumpandmracardiacthetwinreversedarterialperfusiontrapsequenceintwomonochorionicmonoamnioticmcmatwinpregnanciesdiagnosisprognosisandmanagementreviewofliterature
AT gaetanimaria thestrangecaseofdrpumpandmracardiacthetwinreversedarterialperfusiontrapsequenceintwomonochorionicmonoamnioticmcmatwinpregnanciesdiagnosisprognosisandmanagementreviewofliterature
AT dellinomiriam thestrangecaseofdrpumpandmracardiacthetwinreversedarterialperfusiontrapsequenceintwomonochorionicmonoamnioticmcmatwinpregnanciesdiagnosisprognosisandmanagementreviewofliterature
AT vitaglianoamerigo thestrangecaseofdrpumpandmracardiacthetwinreversedarterialperfusiontrapsequenceintwomonochorionicmonoamnioticmcmatwinpregnanciesdiagnosisprognosisandmanagementreviewofliterature
AT malvasiantonio thestrangecaseofdrpumpandmracardiacthetwinreversedarterialperfusiontrapsequenceintwomonochorionicmonoamnioticmcmatwinpregnanciesdiagnosisprognosisandmanagementreviewofliterature
AT cazzatogerardo thestrangecaseofdrpumpandmracardiacthetwinreversedarterialperfusiontrapsequenceintwomonochorionicmonoamnioticmcmatwinpregnanciesdiagnosisprognosisandmanagementreviewofliterature
AT cascardieliano thestrangecaseofdrpumpandmracardiacthetwinreversedarterialperfusiontrapsequenceintwomonochorionicmonoamnioticmcmatwinpregnanciesdiagnosisprognosisandmanagementreviewofliterature
AT marzulloandrea thestrangecaseofdrpumpandmracardiacthetwinreversedarterialperfusiontrapsequenceintwomonochorionicmonoamnioticmcmatwinpregnanciesdiagnosisprognosisandmanagementreviewofliterature
AT alfonsoraffaello thestrangecaseofdrpumpandmracardiacthetwinreversedarterialperfusiontrapsequenceintwomonochorionicmonoamnioticmcmatwinpregnanciesdiagnosisprognosisandmanagementreviewofliterature
AT cicinelliettore thestrangecaseofdrpumpandmracardiacthetwinreversedarterialperfusiontrapsequenceintwomonochorionicmonoamnioticmcmatwinpregnanciesdiagnosisprognosisandmanagementreviewofliterature
AT vimercatiantonella thestrangecaseofdrpumpandmracardiacthetwinreversedarterialperfusiontrapsequenceintwomonochorionicmonoamnioticmcmatwinpregnanciesdiagnosisprognosisandmanagementreviewofliterature