Prenatal diagnosis of fetal heart failure in twin reversed arterial perfusion syndrome

Diagnosis of twin reversed arterial perfusion (TRAP) syndrome is a rare fet al anomaly that can be misdiagnosed on prenatal ultrasound. We confirmed th e use of colour-flow Doppler for prenatal diagnosis of TRAP syndrome and us ed serial fetal echocardiography for non-invasive evaluation of the fetus. A patient with twin intrauterine pregnancy was referred to our centre with suspected intrauterine fetal demise following a 16 week ultrasound. Serial colour-flow Doppler ultrasonography demonstrated retrograde arterial flow i n an acardiac twin. Following diagnosis of TRAP syndrome, serial fetal echo cardiography was employed to follow the normal twin for signs of heart fail ure, including right atrial dilation, tricuspid regurgitation and pericardi al effusion. When early signs of fetal heart failure were suspected a viabl e female infant was delivered at 32 weeks' gestation. We suggest that seria l fetal echocardiography represents a noninvasive approach that can be used to follow fetal cardiac function of the normal twin in TRAP syndrome. Copy right (C) 2000 John Wiley & Sons, Ltd.