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

K. Seo, K. Ichizuka, T. Okai, S. Dohi, M. Nakamura, J. Hasegawa, R. Matsuoka, S. Yoshizawa, S. I. Umemura, M. Nagatsuka, A. Sekizawa

研究成果: Article査読

11 被引用数 (Scopus)

抄録

We describe our experience of high-intensity focused ultrasound (HIFU) for fetal therapy in twin-reversed arterial perfusion (TRAP) sequence. Six pregnant women underwent HIFU therapy, five before 16 weeks and one at 26 weeks. Two types of HIFU system were used: the first-generation system, which comprised a biaxial transducer and continuous exposure pattern, and the second-generation system, which comprised a coaxial transducer and sequential exposure pattern. The first-generation apparatus was used in four cases and the second-generation apparatus was used in two. In three cases, occlusion of the blood vessels mediating flow to the acardiac twin was achieved by HIFU. Two cases experienced intrauterine fetal death despite vessel occlusion. The total survival rate of pump fetuses 2 years after HIFU was 67% and the efficiency rate (the proportion of cases with occlusion or reduced blood flow on ultrasound after HIFU) was 83%. After more than 2 years of follow-up, the surviving infants had no severe clinical complications and no postnatal developmental problems. There was no significant difference in survival rate compared with TRAP cases managed expectantly. Given that complete occlusion of the blood vessels was not achieved in half of the cases, we could not show that HIFU therapy is superior to other treatments. However, HIFU can reduce the cardiac load of the pump fetus and, as it does not require uterine puncture for fetal therapy, there were no fatal complications, such as bleeding, rupture of membranes or infection. Thus, HIFU therapy may represent a less-invasive treatment for TRAP sequence in early pregnancy.

本文言語English
ページ(範囲)128-134
ページ数7
ジャーナルUltrasound in Obstetrics and Gynecology
54
1
DOI
出版ステータスPublished - 2019 7

ASJC Scopus subject areas

  • 放射線技術および超音波技術
  • 生殖医学
  • 放射線学、核医学およびイメージング
  • 産婦人科学

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