Spontaneous Cessation of Communicating Flow in a Twin Reversed-arterial Perfusion with Large Acardiac Twin

Abstract

We report a case of twin reversed-arterial perfusion diagnosed at the gestational age of 17 weeks. Though the acardiac/pump twin abdominal circumference ratio was 1.5, there was no critical Doppler finding of reverse A wave of ductus venosus, polyhydramnios or hydrops of the pump twin at the time of diagnosis, so the patient was regularly followed-up at clinic at 1-week intervals. Two weeks after the diagnosis, the patient requested surgical intervention because she was worried about the risk of heart failure in the pump twin. Fetoscopic guide laser coagulation of the communicating vessels was arranged. On the morning of the operation, cessation of the communicating flow was found, so the operation was cancelled. On the afternoon of the same day, amniocentesis was performed and the pump twin was found to have scalp edema. The patient was followed-up at clinic at 2-week intervals. A healthy female baby was born by vaginal delivery at the gestational age of 36 weeks.