Objective: The study aims to evaluate the efficacy of radiofrequency ablation (RFA) with an internally cooled electrode for twin reversed arterial perfusion (TRAP) sequence. Methods: From April 2008 through December 2014, we retrospectively reviewed all patients who underwent RFA with an internally cooled electrode for TRAP sequence at 3 tertiary referral centers in Japan. Results: Twenty-five monochorionic diamniotic twin pregnancies underwent RFA with an internally cooled electrode for TRAP sequence at 16-27 weeks of gestation. In all cases, umbilical cord blood flow cessation in the acardiac twin was confirmed by ultrasonography with color Doppler. There were 2 cases of procedure-related complications: 1 case of unintentional septostomy and 1 case of anemia in a pump twin. Fetal demise of the pump twin occurred in 3 (12%) cases. Twenty-two (88%) of 25 pump twins were delivered alive. The median gestational age at delivery was 36 + 3 weeks (range 25 + 2-40 + 5 weeks). There were 14 cases (64%) of premature deliveries before 37 weeks and 5 (23%) before 32 weeks. Conclusion: RFA with an internally cooled electrode is a feasible and effective procedure for the treatment of TRAP sequence.

Keywords:
Internally cooled electrode, Radiofrequency ablation, Twin reversed arterial perfusion sequence
1.
Moore TR, Gale S, Benirschke K: Perinatal outcome of forty-nine pregnancies complicated by acardiac twinning. Am J Obstet Gynecol 1990;163:907-912.
2.
Diehl W, Hecher K: Selective cord coagulation in acardiac twins. Semin Fetal Neonatal Med 2007;12:458-463.
3.
Deprest JA, Audibert F, Van Schoubroeck D, Hecher K, Mahieu-Caputo D: Bipolar coagulation of the umbilical cord in complicated monochorionic twin pregnancy. Am J Obstet Gynecol 2000;182:340-345.
4.
Quintero RA, Romero R, Reich H, Goncalves L, Johnson MP, Carreno C, Evans MI: In utero percutaneous umbilical cord ligation in the management of complicated monochorionic multiple gestations. Ultrasound Obstet Gynecol 1996;8:16-22.
5.
Hecher K, Lewi L, Gratacos E, Huber A, Ville Y, Deprest J: Twin reversed arterial perfusion: fetoscopic laser coagulation of placental anastomoses or the umbilical cord. Ultrasound Obstet Gynecol 2006;28:688-691.
6.
Scheier M, Molina FS: Outcome of twin reversed arterial perfusion sequence following treatment with interstitial laser: a retrospective study. Fetal Diagn Ther 2012;31:35-41.
7.
Pagani G, D'Antonio F, Khalil A, Papageorghiou A, Bhide A, Thilaganathan B: Intrafetal laser treatment for twin reversed arterial perfusion sequence: cohort study and meta-analysis. Ultrasound Obstet Gynecol 2013;42:6-14.
8.
Berg C, Holst D, Mallmann MR, Gottschalk I, Gembruch U, Geipel A: Early vs late intervention in twin reversed arterial perfusion sequence. Ultrasound Obstet Gynecol 2014;43:60-64.
9.
Tsao K, Feldstein VA, Albanese CT, Sandberg PL, Lee H, Harrison MR, Farmer DL: Selective reduction of acardiac twin by radiofrequency ablation. Am J Obstet Gynecol 2002;187:635-640.
10.
Lee H, Wagner AJ, Sy E, Ball R, Feldstein VA, Goldstein RB, Farmer DL: Efficacy of radiofrequency ablation for twin-reversed arterial perfusion sequence. Am J Obstet Gynecol 2007;196:459.e1-e4.
11.
Livingston JC, Lim FY, Polzin W, Mason J, Crombleholme TM: Intrafetal radiofrequency ablation for twin reversed arterial perfusion (TRAP): a single-center experience. Am J Obstet Gynecol 2007;197:399.e1-e3.
12.
Jelin E, Hirose S, Rand L, Curran P, Feldstein V, Guevara-Gallardo S, Jelin A, Gonzales K, Goldstein R, Lee H: Perinatal outcome of conservative management versus fetal intervention for twin reversed arterial perfusion sequence with a small acardiac twin. Fetal Diagn Ther 2010;27:138-141.
13.
Paramasivam G, Wimalasundera R, Wiechec M, Zhang E, Saeed F, Kumar S: Radiofrequency ablation for selective reduction in complex monochorionic pregnancies. BJOG 2010;117:1294-1298.
14.
Roman A, Papanna R, Johnson A, Hassan SS, Moldenhauer J, Molina S, Moise KJ Jr: Selective reduction in complicated monochorionic pregnancies: radiofrequency ablation vs. Bipolar cord coagulation. Ultrasound Obstet Gynecol 2010;36:37-41.
15.
Bebbington MW, Danzer E, Moldenhauer J, Khalek N, Johnson MP: Radiofrequency ablation vs bipolar umbilical cord coagulation in the management of complicated monochorionic pregnancies. Ultrasound Obstet Gynecol 2012;40:319-324.
16.
Lee H, Bebbington M, Crombleholme TM; North American Fetal Therapy Network: The North American Fetal Therapy Network registry data on outcomes of radiofrequency ablation for twin-reversed arterial perfusion sequence. Fetal Diagn Ther 2013;33:224-229.
17.
Cabassa P, Fichera A, Prefumo F, Taddei F, Gandolfi S, Maroldi R, Frusca T: The use of radiofrequency in the treatment of twin reversed arterial perfusion sequence: a case series and review of the literature. Eur J Obstet Gynecol Reprod Biol 2013;166:127-132.
18.
Lu J, Ting YH, Law KM, Lau TK, Leung TY: Radiofrequency ablation for selective reduction in complicated monochorionic multiple pregnancies. Fetal Diagn Ther 2013;34:211-216.
19.
Argoti PS, Bebbington MW, Johnson A, Moise KJ Jr: Indirect pump: unique presentation of a monochorionic-triamniotic triplet gestation complicated by TRAP sequence and successfully managed with radiofrequency ablation of the acardiac fetus. Ultrasound Obstet Gynecol 2013;42:115-117.
20.
Kumar S, Paramasivam G, Zhang E, Jones B, Noori M, Prior T, Vasudeva A, Wimalasundera RC: Perinatal- and procedure-related outcomes following radiofrequency ablation in monochorionic pregnancy. Am J Obstet Gynecol 2014;210:454.e1-e6.
21.
Yinon Y, Ashwal E, Weisz B, Chayen B, Schiff E, Lipitz S: Selective reduction in complicated monochorionic twins: prediction of obstetric outcome and comparison of techniques. Ultrasound Obstet Gynecol 2015, Epub ahead of print.
22.
Hirose M, Murata A, Kita N, Aotani H, Takebayashi K, Noda Y: Successful intrauterine treatment with radiofrequency ablation in a case of acardiac twin pregnancy complicated with a hydropic pump twin. Ultrasound Obstet Gynecol 2004;23:509-512.
23.
Weichert A, Kalache K, Hein P, Brauer M, Hinkson L, Henrich W: Radiofrequency ablation as a minimally invasive procedure in the treatment of twin reversed arterial perfusion sequence in twin pregnancy. J Clin Ultrasound 2013;41:245-247.
24.
Park HJ, Lee MW, Song KD, Cha DI, Rhim H, Kang TW, Lim S, Lim HK: Comparison of therapeutic efficacy and safety of radiofrequency ablation of hepatocellular carcinomas between internally cooled 15-G and 17-G single electrodes. Br J Radiol 2014;87:20130534.
25.
Rossi S, Buscarini E, Garbagnati F, Di Stasi M, Quaretti P, Rago M, Zangrandi A, Andreola S, Silverman D, Buscarini L: Percutaneous treatment of small hepatic tumors by an expandable RF needle electrode. AJR Am J Roentgenol 1998;170:1015-1022.
26.
Solbiati L, Goldberg SN, Ierace T, Livraghi T, Meloni F, Dellanoce M, Sironi S, Gazelle GS: Hepatic metastases: percutaneous radio-frequency ablation with cooled-tip electrodes. Radiology 1997;205:367-373.
27.
Shibata T, Shibata T, Maetani Y, Isoda H, Hiraoka M: Radiofrequency ablation for small hepatocellular carcinoma: prospective comparison of internally cooled electrode and expandable electrode. Radiology 2006;238:346-353.
28.
Teratani T, Yoshida H, Shiina S, Obi S, Sato S, Tateishi R, Mine N, Kondo Y, Kawabe T, Omata M: Radiofrequency ablation for hepatocellular carcinoma in so-called high-risk locations. Hepatology 2006;43:1101-1108.
29.
Sutherland LM, Williams JA, Padbury RT, Gotley DC, Stokes B, Maddern GJ: Radiofrequency ablation of liver tumors: a systematic review. Arch Surg 2006;141:181-190.
30.
Dupuy DE, DiPetrillo T, Gandhi S, Ready N, Ng T, Donat W, Mayo-Smith WW: Radiofrequency ablation followed by conventional radiotherapy for medically inoperable stage I non-small cell lung cancer. Chest 2006;129:738-745.
31.
Takaki H, Nakatsuka A, Uraki J, Yamanaka T, Fujimori M, Hasegawa T, Arima K, Sugimura Y, Yamakado K: Renal cell carcinoma: radiofrequency ablation with a multiple-electrode switching system - a phase II clinical study. Radiology 2013;267:285-292.
32.
Weisz B, Peltz R, Chayen B, Oren M, Zalel Y, Achiron R, Lipitz S: Tailored management of twin reversed arterial perfusion (TRAP) sequence. Ultrasound Obstet Gynecol 2004;23:451-455.
33.
Lewi L, Valencia C, Gonzalez E, Deprest J, Nicolaides KH: The outcome of twin reversed arterial perfusion sequence diagnosed in the first trimester. Am J Obstet Gynecol 2010;203:213.e1-e4.
34.
Chaveeva P, Poon LC, Sotiriadis A, Kosinski P, Nicolaides KH: Optimal method and timing of intrauterine intervention in twin reversed arterial perfusion sequence: case study and meta-analysis. Fetal Diagn Ther 2014;35:267-279.
© 2016 S. Karger AG, Basel
2016
Copyright / Drug Dosage / Disclaimer
Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.
You do not currently have access to this content.