Poor Long-term Outcome in a Survivor Presenting with the Twin Reversed Arterial Perfusion Sequence In Utero: A Case Report

雙胞胎逆轉動脈灌流的長期追蹤結果：病例報告

陳至真(Chih-Chen Chen) ； 許毓馨(Yu-Hsin Hsu) ； 詹德富(Te-Fu Chan) ； 袁行修(Shyng-Shiou F. Yuan) ； 蘇鈞煌(Jinu-Huang Su)

《The Kaohsiung Journal of Medical Sciences》 19卷10期 (2003/10) Pp. 526-530

摘要

雙胞胎發生逆轉動脈灌流（TRAP）是極為罕見的。它是指幫浦雙胞胎通過動脈血管交通，將血液逆流給接受者雙胞胎，後者往往有多重畸形，但主要是沒有發生心臟畸形。若未積極治療，致死率超過50%，且常併發早產、羊水過多、心衰竭、子宮內死亡等。早期診斷需依賴仔細的超音波檢查。本文報告一位倖存之幫浦雙胞胎，經過3年的追蹤期，發現案例之神經學上預後極差，包括神經性失聰、腦性麻痺、嚴重智力及運動發展遲緩。

關鍵字

無心畸型雙胞胎 ； 單一絨毛膜雙胞胎 ； 雙胞胎逆轉動脈灌流

並列摘要

The twin reversed arterial perfusion (TRAP) sequence is a very rare complication of multiple gestations and is associated with a high mortality rate, reaching more than 50% in pump twins. The four common complications are preterm labor, polyhydramnios, fetal congestive heart failure, and fetal death of the pump twin in utero. Prenatal diagnosis during early pregnancy is possible using detailed ultrasonographic examination. Therapies, including conservative treatment and invasive procedures, are directed toward achieving optimal maintenance of pump twins based on clinical presentation. Risk factors for pump twin mortality include a high twin-to-twin weight ratio, acardiacus anceps, low umbilical artery pulsatility index, and a rapid growth rate in the acardiac twin. Herein, we present a case of TRAP sequence in a patient who underwent conservative treatment and had a poor neurologic outcome during long-term follow-up. Although the experience is still limited, early diagnosis of TRAP sequence and more aggressive treatment, instead of an expectant approach, might be a better option.

並列關鍵字

acardiac twin ； monochorionic twin ； twin reversed arterial perfusion sequence