Treatment of twin‐reversed arterial perfusion sequence using high‐intensity focused ultrasound

Abstract

The aim of this study was to clinically evaluate the efficacy of high-intensity focused ultrasound (HIFU) for fetal therapy of twin-reversed arterial perfusion (TRAP) sequence. Six patients underwent HIFU therapy: five patients during the first trimester and one patient during the second trimester. In this study, two types of HIFU systems were used. The first-generation HIFU system comprised a biaxial transducer and continuous exposure pattern. The second-generation HIFU system comprised a coaxial transducer and sequential exposure pattern. The first-generation apparatus was used in four cases, and the second-generation apparatus was used in two cases. For three patients, blood vessels to the acardiac twin had been occluded. Two patients had intrauterine fetal demise despite vessel occlusion. The total fetal survival rate was 67%, and the efficiency rate was 83% after HIFU therapy. After more than 2 years of follow-up, the surviving infants had no severe clinical complications and no postnatal development problems. There was no significant difference in survival rates. However, owing to its efficiency rate, HIFU therapy is beneficial and can reduce the cardiac load of the pump fetus. Given that complete occlusion of the blood vessels was not achieved in almost half of these cases, we could not show that HIFU therapy is superior to other treatments. However, HIFU does not require uterine puncture for fetal therapy. Hence, there were no fatal complications, such as bleeding, rupture of membranes, and infection. Thus, HIFU therapy might be one of the less invasive treatment methods for TRAP sequence in early pregnancy. This article is protected by copyright. All rights reserved.

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