American Journal of Obstetrics & Gynecology
Volume 196, Issue 5 , Pages 459.e1-459.e4, May 2007

Efficacy of radiofrequency ablation for twin-reversed arterial perfusion sequence

Presented at the 25th Annual Meeting of the Society of Maternal-Fetal Medicine, Reno, Nevada, February 2005.

  • Hanmin Lee, MD

      Affiliations

    • Fetal Treatment Center and the Department of Surgery, University of California, San Francisco, San Francisco, CA
    • Corresponding Author InformationReprint requests Hanmin Lee, MD, UCSF Fetal Treatment Center, 513 Parnassus Ave, Suite HSW 1601, San Francisco, CA 94143-0570
    • ,
  • Amy J. Wagner, MD

      Affiliations

    • Fetal Treatment Center and the Department of Surgery, University of California, San Francisco, San Francisco, CA
    • ,
  • Edgar Sy, MD

      Affiliations

    • Fetal Treatment Center and the Department of Surgery, University of California, San Francisco, San Francisco, CA
    • ,
  • Robert Ball, MD

      Affiliations

    • Fetal Treatment Center and the Department of Surgery, University of California, San Francisco, San Francisco, CA
    • Department of Obstetrics, Gynecology, Reproductive Sciences, University of California, San Francisco, San Francisco, CA
    • Department of Radiology, University of California, San Francisco, San Francisco, CA.
    • ,
  • Vickie A. Feldstein, MD

      Affiliations

    • Department of Radiology, University of California, San Francisco, San Francisco, CA.
    • ,
  • Ruth B. Goldstein, MD

      Affiliations

    • Department of Obstetrics, Gynecology, Reproductive Sciences, University of California, San Francisco, San Francisco, CA
    • Department of Radiology, University of California, San Francisco, San Francisco, CA.
    • ,
  • Diana L. Farmer, MD

      Affiliations

    • Fetal Treatment Center and the Department of Surgery, University of California, San Francisco, San Francisco, CA

Received 23 May 2006; received in revised form 27 September 2006; accepted 30 November 2006.

Objective

We report our experience in the treatment of patients with twin-reversed arterial perfusion (TRAP) sequence using radiofrequency ablation to stop perfusion to the acardiac twin and protect the pump twin.

Study Design

An IRB approved retrospective review of all patients (n = 29) who underwent percutaneous radiofrequency ablation of an acardiac twin, using ultrasound guidance and either a 14 or 17 gauge radiofrequency needle for twin-reversed arterial perfusion sequence, from 1998 to 2005, was performed by review of hospital and outpatient medical records.

Results

The outcomes of all 29 of the patients treated with radiofrequency ablation are known. Twenty-six of the patients had monochorionic-diamniotic pregnancies, whereas 2 had monochorionic-monoamniotic pregnancies. One patient had a triplet pregnancy with a monochorionic-diamniotic pair with TRAP sequence. Overall, 25 of 29 pump twins survived (86%), delivering at a mean gestational age of 34.6 weeks. Survival was 24 of 26 (92%) in monochorionic-diamniotic pregnancies with a mean gestational age of 35.6 weeks. Two women in our early experience sustained thermal injuries from the site of grounding pads.

Conclusion

Radiofrequency ablation of the acardiac twin effectively protects the pump twin from high-output cardiac failure and death. Greater than 90% survival can be achieved in monochorionic-diamniotic pregnancies complicated by TRAP sequence with a mean gestation age at time of delivery close to term. Our limited experience in cases of monochorionic-monoamniotic TRAP sequence does not allow the determination of efficacy in this group.

Key words: acardiac, monochorionic-diamniotic pregnancy, radiofrequency ablation, TRAP sequence

 

 Cite this article as: Lee H, Wagner AJ, Sy E, et al. Efficacy of radiofrequency ablation for twin-reversed arterial perfusion sequence. Am J Obstet Gynecol 2007;196;459.e1-459.e4.

PII: S0002-9378(06)02411-2

doi:10.1016/j.ajog.2006.11.039

American Journal of Obstetrics & Gynecology
Volume 196, Issue 5 , Pages 459.e1-459.e4, May 2007