ABLATION OF ACARDIAC TWIN BY ALCOHOL INFECTION INTO THE INTRAABDOMINAL UMBILICAL ARTERY

Background: Twin reversed arterial perfusion sequence is a rare compli cation of monochorionic twinning, in which the normal pump twin perfus es the abnormal acardiac twin in a reversed fashion via an artery-to-a rtery placental anastomosis. Mortality in the normal twin exceeds 50% as a result of preterm labor, polyhydramnios, and congestive heart fai lure. Case: A twin pregnancy complicated by the twin reversed arterial perfusion sequence developed early hemodynamic decompensation in the pump twin with increasing size of the acardiac twin. Ablation of the a cardiac twin at 23 weeks' gestation was achieved successfully by injec ting 1 mL of absolute alcohol into the intra-abdominal portion of the single umbilical artery. Conclusion: Direct ultrasound-guided intravas cular injection of absolute alcohol is an easy and straightforward tec hnique to occlude circulation to the acardiac twin. This vessel can be identified easily by color Doppler ultrasonography away from the main venous trunk. Selection of this target, rather than occlusion at the level of the umbilical cord, could reduce the risks of cord accidents and inadvertent intravenous injection of the ablative material.