Twin-reversed arterial perfusion syndrome, with rudimentary heart

Nilda Sanchez, MD, M. Freire, MD, Alejandro d´Huicque, MD

Quilmes, Buenos Aires, Argentina

This is a set of twins with a Twin-reversed arterial perfusion (TRAP) syndrome. The "acardiac" twin in this unusual case has a a rudimentary heart, anencephaly, a large midline cleft-lip. ambiguous genitalia and an imperforated anus. The pump twin survived only 72 hours.

The TRAP fetus with the anasarca, large pleural effusions, cysts and ascites:

The rudimentary head and the spine.

The limbs.

The rudimentary heart is visible not only in Doppler but even on M-mode. The cardiac contraction is inefficient though and the flow in the aorta is retrograde. The fetus has a 2-vessel cord.

The newborn: note the anencephaly, a large midline cleft-lip. ambiguous genitalia and an imperforated anus. The limbs are unusually well developed for a TRAP.