Document Detail


Intrafetal alcohol chemosclerosis of acardiac twins: a multicenter experience.
MedLine Citation:
PMID:  15305102     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
OBJECTIVE: To report a multicenter experience with intrafetal alcohol chemosclerosis in the treatment of pregnancies complicated with the twin reversed arterial perfusion sequence. METHODS: Percutaneous injection of 1- 2 ml of absolute alcohol into the intra-abdominal segment of the single umbilical artery was performed in 8 acardiac twins. Cases were collected from 5 centers following a standardized protocol. The procedure was performed under continuous ultrasound control, using color Doppler ultrasound to identify the main arterial vessel entering the abdomen of the acardiac twin and passing a 20-gauge spinal needle into the targeted vessel. Intraoperative and short-term complications were noted. Information on pregnancy outcome was obtained by reviewing the medical records or contacting the referring obstetrician. RESULT: At the time of the procedure, the acardiac twin was severely hydropic and the size exceeded 70% of the size of the pump twin in all cases. In addition, there were associated complications in all the pump twins including polyhydramnios in 8 cases (100%), cardiac insufficiency in 5 (63%), and fetal growth restriction in 1 (13%). The procedure was performed at a mean gestational age of 24.7 weeks (range 20-32), and it was technically successful in all cases. However, it was complicated with thrombosis of the umbilical vessels of the pump twin in 1 case, and transient bradycardia in 2 others. These 3 pump twins died in utero as a result of the procedure. The other 5 procedures were technically and clinically successful, resulting in an overall survival rate of 63%. In 4 pregnancies, the pump twin was delivered after 35 weeks and had no neonatal complications. CONCLUSIONS: Intrafetal alcohol chemosclerosis is a simple procedure that can be performed in any fetal medicine center around the world to stop the vascular supply to acardiac twins. However, the main concern with this technique is intravascular transfer of the ablative material to the circulation of the pump twin. The use of this technique should therefore be restricted to those pregnancies with poor prognostic factors and in countries where more sophisticated methods for the treatment of this condition are not available.
Authors:
Waldo Sepulveda; Edgardo Corral; Horacio Aiello; Lucas Otaño; Ricardo Paredes; Maria F Escobar; Fernando Heredia; Victor Quiroz
Publication Detail:
Type:  Case Reports; Journal Article; Multicenter Study    
Journal Detail:
Title:  Fetal diagnosis and therapy     Volume:  19     ISSN:  1015-3837     ISO Abbreviation:  Fetal. Diagn. Ther.     Publication Date:    2004 Sep-Oct
Date Detail:
Created Date:  2004-08-12     Completed Date:  2005-01-31     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  9107463     Medline TA:  Fetal Diagn Ther     Country:  Switzerland    
Other Details:
Languages:  eng     Pagination:  448-52     Citation Subset:  IM    
Copyright Information:
Copyright 2004 S. Karger AG, Basel
Affiliation:
Fetal Medicine Center, Clinica Las Condes, Santiago, Chile. waldosep@hotmail.com
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MeSH Terms
Descriptor/Qualifier:
Diseases in Twins / therapy*
Ethanol / administration & dosage*
Female
Fetal Diseases / therapy*
Fetal Heart / abnormalities*
Fetofetal Transfusion / therapy*
Fetoscopy
Gestational Age
Humans
Infant, Newborn
Injections, Intra-Arterial
Pregnancy
Sclerosing Solutions / administration & dosage*
Treatment Outcome
Twins, Monozygotic
Umbilical Arteries
Chemical
Reg. No./Substance:
0/Sclerosing Solutions; 64-17-5/Ethanol

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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