Fetal cardiac failure - acardiac twin - monochorial pregnancy

Discussion:

This case emphasizes US findings in high-output fetal cardiac failure at a late stage.

In this case, twin B's fetal cardiac output failure is due to a vascular steal syndrome from his acardiac, malformed, monochorial twin (the equivalent of a high flow tumor).

Other causes of fetal cardiac failure include complex cardiac malformations, anemia (from Rhesus alloimmunisation, or from fetal infections), vascular steal syndrome from arterioveinous malformations (for example Galen vein malformation) or from hypervascular fetal tumors, and other syndromic conditions.  

Acardiac twin is one of the 3 classic complications of a monochorionic diamniotic pregnancy, with Twin-to-twin transfusion syndrome (TTTS) and Twin-Anemia-Polycythemia Syndrome (TAPS). Physiopathology of these complications involve arterio-arterial placental anastomosis (TTTS and acardiac twin) or arterio-veinous placental anastomosis (TAPS).

Watchful follow up of monochorial diamniotic pregnancies is useful to plan in utero treatment before fetal demise.

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