Study on the ultrasonic imaging characteristics of the twin reversed arterial perfusion sequence-hemiacardius

Abstract

Objective To explore the ultrasonic characteristics of the twin reversed arterial perfusion (TRAP) sequence-hemiacardius. Methods A retrospective analysis of the clinical data and ultrasonic characteristics of 9 cases with the TRAP was made, which were compared with the pathlogical result after delivery. Results The prenatal ultrasonic imaging characteristics showed: The vestigial heart′s pulsating was seen in all the hemiacardius twin′s thoracic cavity, and the Doppler spectrum in it went up and down.It was noted that the heart rate was slower in the better (multicavity) development of the heart and faster in the poor development (pipe type and single cavity) of the heart. Nine hemiacardius twin had hydroderma and cystic hygroma. The head, spine, abdominal organs (both kindenys and intestines) of all the 9 cases were hypogenetic. The diaphragm was present in 7 cases; lower limbs was present in 8 cases, single leg was seen in one case; upper limbs was present in 7 cases. Seven cases of the pump twin suffered from the cardiac insufficiency. Polyhydramnios were seen in 5 cases. Prognosis of the 9 cases of the TRAP pump twin: the cessation of blood flow spontaneous was seen in one case, the pump twin was survived and delivered at term. Eight cases were demise(2 cases with intrauterine demise, 5 cases induced labor with cardiac insufficiency, 1 case died from polyhydramnios after premature birth). Conclusions The pump twin of the TRAP hemiacardiacs have a poor prognosis with the nautural course, and are easy to suffer from the cardiac insufficiency in utero. The ultrasonography can diagnose the TRAP hemiacardius accurately, which can be used to guide the clinical doctors to choose a reasonable timing to take intrauterine treatment, that will effectively improve the survival rate of the pump twin. Key words: Ultrasonography; Twin reversed arterial perfusion sequence; Hemiacardius; Acardiac