Wong Amy E, Sepulveda Waldo
Fetal Medicine Center, Department of Obstetrics and Gynecology, Clinica Las Condes, Santiago, Chile.
Prenat Diagn. 2005 Sep;25(9):796-806. doi: 10.1002/pd.1269.
Acardiac anomaly is a rare condition affecting monochorionic multiple pregnancies. We review this condition with emphasis on its prenatal diagnostic features and treatment options. Due to the parasitic hemodynamic dependence of the acardiac twin on the pump twin, it is important to monitor the pump twin for signs of decompensation and, if indicated, intervene by interrupting vascular supply to the acardiac twin. The goal of treatment is to maximize the pump-twin's chance of survival. To assist with the decision of when to treat, we suggest a new classification system based on prognostic factors, specifically the size and growth of the acardiac twin and the cardiovascular condition of the pump twin. When the acardiac twin is small and no signs of cardiovascular impairment in the pump twin are present, we suggest serial ultrasound surveillance to detect any worsening of the condition. In cases with a large acardiac twin or rapid growth of the acardiac mass, we recommend prompt intervention. Once treatment is indicated, the intrafetal approach to interrupt the vascular supply to the acardiac twin appears to be superior to cord occlusion techniques as it is simpler, safer and more effective. The first line of treatment, if available, should be ultrasound-guided laser coagulation or radiofrequency ablation of the intrafetal vessels.
无心畸形是一种影响单绒毛膜多胎妊娠的罕见病症。我们对该病症进行综述，重点关注其产前诊断特征及治疗方案。由于无心双胎对供血双胎存在寄生性血流动力学依赖，因此监测供血双胎是否出现失代偿迹象并在必要时通过中断向无心双胎的血管供应进行干预非常重要。治疗的目标是最大程度提高供血双胎的存活几率。为辅助决定治疗时机，我们基于预后因素，特别是无心双胎的大小和生长情况以及供血双胎的心血管状况，提出一种新的分类系统。当无心双胎较小且供血双胎未出现心血管损害迹象时，我们建议进行系列超声监测以检测病情是否恶化。对于无心双胎较大或无心团块快速生长的病例，我们建议及时干预。一旦确定需要治疗，经胎儿体内途径中断向无心双胎的血管供应似乎优于脐带闭塞技术，因为它更简单、更安全且更有效。如果可行，一线治疗方法应为超声引导下对胎儿体内血管进行激光凝固或射频消融。
