The First Time in Iran-Microwave Ablation of Acardiac Twin by SUMS Physicians

Acardiac twinning or twin reversed arterial perfusion (TRAP) sequence is one of the rarest complications of monochorionic twin pregnancies where intrafetal therapy is crucial to prevent fetal demise. Dr. Homeira Vafaiee, the head of Perinatology Department at Shiraz University of Medical Sciences (SUMS), explained that TRAP sequence occurs in approximately 1% of monochorionic twin pregnancies in which one twin is usually structurally normal while the other is severely malformed and is only an abnormal mass of tissue whose blood circulatory system is connected to the normal fetus called “pump twin”. The abnormal twin or the “acardiac twin” and the “pump twin” are connected via unique vascular connections; arterio-arterial anastomosis, on the surface of the shared placenta. The acardiac twin lacks a beating heart; thus, the pump twin derives blood through both fetus which causes an extra burden on the pump twin and consequently contributes to heart failure.  If any urgent treatment, therefore, is not taken into account, it is proved that intrauterine fetal death occurs in approximately 30% of pump twins.

She continued that to ablate the acardiac twin so as to rule out abnormalities in the pump twin and to avert its death, different procedures including Microwave ablation, fetoscopic cord occlusion, radio-frequency ablation, or laser ablation are administered. Among the aforementioned methods, Microwave ablation is the most successful one which increases the survival chance of the pump twin to about 80%.  As Dr. Vafaiee remarked, for the first time in Iran, Microwave ablation was carried out on a 26-year old woman pregnant with an acardiac twin pregnancy. She maintained that Microwave ablation as the least invasive procedure that greatly reduces the operation time was chosen for this ideal candidate. During the operation, the artery blood flow of the acardiac twin was occulted by the microwave laser device for 3 minutes. Post operation procedure reveals a complete block of blood flow in the acardiac twin and the successful survival of the pump twin. The operation was performed at SUMS central Hospital by SUMS surgeons including Dr. Homeira Vafaiee, Dr. Nasrin Asadi, Dr. Saman Nik-eghbal, Dr. Shohreh Roozmah, Dr. Maryam Kasraian, Dr. Hamid Reza Forootan, Dr. Azam Faraji, and Dr. Mitra Mehrban, Dr. Vafaiee concluded.