Published: 2022-08-29

Successful management of pump twin

Hemamalini Rajamanikkam, Anupritha Arudhra Hamshadhwanaa


Acardiac twinning is one of the rare but important complication of monochorionic twin pregnancies leading to increased perinatal mortality of both twins. Since one of the twins did not have well developed cardiac structure it depended on the co-twin for blood supply. This increases mortality of co twin. We reported a case of acardiac twin diagnosed at proper time managed with interstitial laser occlusion of cord at appropriate time with successful outcome of normal co-twin. This case highlighted the importance of early diagnosis, proper timing and selection of vascular occlusion procedure to occlude blood flow to acardiac twin and close surveillance and delivery of donor twin, to improve perinatal outcome.


Acardiac twin, TRAP sequence, Pump twin

Full Text:



Hecher K, Ville Y, Nicolaides KH. Color Doppler ultrasonography in the identification of communicating vessels in twin-twin transfusion syndrome and acardiac twins. J Ultrasound Med. 1995;14(10):37-40.

Nanthakomon T, Chanthasenanont A, Somprasit C, Manusook S, Pongrojpaw D, Suwannarurk K. Twin reversed arterial perfusion (TRAP) sequence: a case report and review of treatment. J Med Assoc Thai. 2015;98(3):132-40.

Athwal S, Millard K, Lakhoo K. Twin reverse arterial perfusion (TRAP) sequence in association with VACTERL anomalies. A case report. J Med Care Rep. 2010;22(4):411.

Moore TR, Gale S, Benirschke K. Perinatal outcome of fortynine pregnancies complicated by acardiac twinning. Am J Obstet Gynaecol. 1990;163(3):907-12.

Pinet C, Colau JC, Delezoide AL, Menez F. Acardiac twins. J Gynaecol Obstet Biol Reprod (Paris). 1994;23:85-92.

Wong AE, Sepulveda W. Acardiac anomaly: current issues in prenatal assessment and treatment. Prenat Diagn. 2005;25(9):796-806.

Hartge DR, Weichert J. Prenatal diagnosis and outcome of multiple pregnancies with reversed arterial perfusion (TRAP-sequence). Arch Gynaecol Obstet. 2012;286(1):81-5.