Prognostic Markers in Twin Pregnancies With an Acardiac Fetus

Intrafetal alcohol ablation of an acardiac twin

“…5,17,18 Other prognostic factors include the twin weight ratio, umbilical doppler indices and cardiovascular status. 19 Should there be the need to intervene, the main intervention is to disconnect the circulation between the two fetuses via fetoscopic or ultrasound guided occlusive techniques.…”

Fetal Echocardiography and Prenatal Cardiovascular Interventions – An Update (2012)

“…Fetal anemia is the most common pathology in this category, and intrauterine transfusions, one of the first successful forms of invasive intrauterine intervention [101,102]. More recently, various groups have explored such therapy for less common lesions associated with high output states including arteriovenous malformations [103][104][105] and acardiac twin gestations [97,106]. From observations made in fetuses with arteriovenous MR1 formations, it has been suggested that when the fetal combined output exceeds nearly 2-fold the normal combined cardiac output the fetus may evolve hydrops or demise [107], an observation which may be applicable to other fetal high output states.…”

“…If the acardiac twin has high resistance, which is more typical of smaller masses, there is minimal change in the cardiac output of the healthy twin. When the vascular resistance of the acardiac twin is low, more typical of the larger masses, the healthy twin may pump a significant amount of its output to the nonviable twin and eventually evolve high output heart failure [106]. Cord ligation and direct laser photocoagulation of the cord as it enters the acardiac mass have been successful invasive techniques that have nearly eliminated the disastrous [109,110].…”

“…Finally, fetal goiter associated with hyperthyroidism is a rare cause of high cardiac output which, unlike other causes, is associated with fetal sinus tachycardia [111]. Fetal echocardiography surveillance is particularly useful for these lesions, both in assisting with determining need for and timing of intervention and delivery as well as success of fetal intervention [97,102,106,107].…”

Oclusão da artéria umbilical como opção terapêutica em gestações com gêmeo acárdio

“…O gêmeo normal comumente apresenta insuficiência cardíaca secundária à sobrecarga circulatória e ao rápido crescimento do gêmeo acárdio. Além disso, há risco de parto prematuro em conseqüência do poliidrâmnio 3 . Em virtude das complicações cardiovasculares potencialmente letais ao gêmeo sadio, vá-rias modalidades terapêuticas têm sido propostas, com ênfase aos procedimentos invasivos que visam interromper a perfusão do gêmeo acárdio 4 .…”