Acardius or "twin-reversed arterial perfusion" sequence. Report on four cases and review of current therapeutic possibilities

We describe four cases of acardius (one of hemiacardius, two of holoacardiu s acephalus,and one of holacardius amorphus) and present the current range of therapeutic possibilities: control of amniotic fluid by repeated amnioce ntesis or indomethacin therapy, administration of digoxin to the mother, se lective preterm delivery of the acardiac twin by hysterotomy, interruption of the anastomoses by injection of thrombogenic coils, sclerosing agents, u mbilical cord ligation, fetoscopic laser coagulation, and thermocoagulation .