Section of Fetal Therapy and Fetal Surgery Unit, Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology Hospital de San José, Department of Obstetrics and Gynecology Fundación Universitaria de Ciencias de la Salud - FUCS, Bogota, Colombia.
Fetal Therapy and Surgery Network - FetoNetwork, Bogota, Colombia.
Fetal Diagn Ther. 2023;50(6):446-453. doi: 10.1159/000531791. Epub 2023 Aug 3.
The optimal approach and therapy method for the acardiac twin with a reverse arterial perfusion sequence has not yet been established. The aim of this study was to determine the clinical practice patterns among international fetal therapy units in their management of these cases.
A survey was sent to fetal centers across the world via email between December 2020 and December 2021.
Responses were obtained from 77% contacted centers. The most frequent ultrasound variables used in the evaluation of twin reverse arterial perfusion sequence include echocardiographic assessment of the pump twin and umbilical artery Doppler waveforms in the acardiac and pump twins, in 90% and 80% of the centers, respectively. Most centers in Europe and Latin America propose an in utero intervention in all cases. Most centers in Europe and Latin America prefer interstitial laser ablation, whereas radiofrequency ablation (RFA) is preferred in North America. The earliest gestational age for an intervention is on mean 13 weeks in Europe, which is earlier than the other geographic areas (p = 0.001).
Most centers agreed that antenatal evaluation should include echocardiography along with the UA Doppler waveform measurements, and the most frequently used interventions were interstitial laser ablation or RFA at a median between 14 and 26 weeks.
心脏反向灌注序列无心畸形儿的最佳处理方法和治疗方式尚未确定。本研究旨在确定国际胎儿治疗中心在处理此类病例时的临床实践模式。
2020 年 12 月至 2021 年 12 月期间，通过电子邮件向全球胎儿中心发送了一份调查。
联系的中心中有 77%做出了回应。评估双胎反向动脉灌注序列的最常见超声变量包括心脏畸形儿和泵胎的超声心动图评估以及脐动脉多普勒波形，分别有 90%和 80%的中心采用。欧洲和拉丁美洲的大多数中心建议对所有病例进行宫内干预。欧洲和拉丁美洲的大多数中心倾向于间质激光消融，而北美的中心则倾向于射频消融（RFA）。干预的最早妊娠周数在欧洲平均为 13 周，早于其他地理区域（p = 0.001）。
大多数中心均认为，产前评估应包括超声心动图以及 UA 多普勒波形测量，最常采用的干预措施是在 14 至 26 周之间进行间质激光消融或 RFA。
