Monopolar Thermocoagulation in the Management of Acardiac Twins

Abstract

Objective: To demonstrate the equipment setup and the application of monopolar thermocoagulation in the management of acardiac twins. Methods: We described 2 cases of acardiac acephalus twins who developed congestive heart failure and polyhydramnios at 20 weeks of gestation. A monopolar wire electrode was inserted through a 14-gauge trocar under ultrasound guidance. The inter-twin circulation was interrupted and confirmed by color Doppler flow examination. Results: Case 1 was detected at 20 weeks of gestation with progression to early signs of fetal congestive heart failure at 22 weeks. This case had smooth operative procedure and delivered a healthy infant at 32 weeks. Case 2 was referred at 24 weeks of gestation with marked fetal congestive heart failure. Although thermocoagulation cessed the inter-twin perfusion, the fetus died in utero 12 h later with persistent irreversible circulatory compensation. Conclusion: Monopolar thermocoagulation was an effective and generally available alternative technique to fetal endoscopic surgery for the interruption of vascular communication between acardiac twins.

Optimal Method and Timing of Intrauterine Intervention in Twin Reversed Arterial Perfusion Sequence: Case Study and Meta-Analysis

“…In the past 3 decades, several methods for intrauterine intervention have been developed, aiming to improve the outcome for the pump twin [2,3,4,5,6,7,8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58,59,60,61,62,63,64,65,66,67,68,69,70,71,72,73,74,75]. Most studies in the literature have reported treatment in 1-10 cases, with only a handful examining larger series.…”

Treatment of twin‐reversed arterial perfusion sequence using high‐intensity focused ultrasound

“…Various treatment methods for TRAP sequence, such as cord occlusion [17][18][19][20] , anastomotic vessel ablation 21,22 and intra-acardiac fetal ablation techniques, have been reported 23,24 . RFA provides good results owing to its relatively low invasiveness and ease of treatment 20,[25][26][27][28][29] .…”

Ultrasound-Guided Percutaneous Microwave Coagulation Therapy with a “Cooled-tip Needle” for the Treatment of Hepatocellular Carcinoma Adjacent to the Gallbladder

“…Recently, a perfusion electrode, known as a ''cooled-tip'' needle, has been developed and serves as a more powerful tool for creating larger volumes of necrosis in less time than the old monopolar technique [23,24]. The continuous cooling of the needle tip via circulation of chilled saline allows for greater transmission of microwave energy into the tissues and permits heating and necrosis far from the electrode without tissue charring [25].…”