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From monster to twin reversed arterial perfusion: a history of acardiac twins
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Michael Obladen
Published/Copyright:
February 2, 2010
Abstract
A human being born without heart and head, i.e., the acardius/acranius malformation, has been described since antiquity. Superstition and fear made it a mystical disorder, a sign of God's wrath. The inquisition ruled that acranic infants should not be baptized and located the soul in the brain. Acardia was not associated with twin gestation until the reports of Mery in 1720 and Winslow in 1740. In 1850, Meckel identified the pathogenetic mechanism as reversed perfusion due to large arterio-arterial and veno-venous anastomoses; he believed the heart would fail to develop or arrest during development, and the acardiac fetus would be maintained by arterial perfusion from the pump twin. In 1859, Claudius articulated that after normal initial development, the heart degenerates when reversed flow in the aorta leads to thrombosis. Today, it is assumed that both mechanisms may exist. With the advent of prenatal ultrasound diagnosis and radiofrequency ablation of the acardiac twin's circulation, it became possible to save the pump twin.
Keywords: Acardius; acranius; history; placental anastomoses; TRAP sequence; twin reversed arterial perfusion
Received: 2009-11-13
Accepted: 2009-12-7
Published Online: 2010-02-02
Published Online: 2010-02-2
Published in Print: 2010-05-01
©2010 by Walter de Gruyter Berlin New York
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Keywords for this article
Acardius;
acranius;
history;
placental anastomoses;
TRAP sequence;
twin reversed arterial perfusion
Articles in the same Issue
- Editorial
- Recommendations and guidelines for perinatal practice
- Optimization of human milk fortification for preterm infants: new concepts and recommendations
- Review articles
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- From monster to twin reversed arterial perfusion: a history of acardiac twins
- Original articles – Obstetrics
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- Detection of ureaplasmas by the polymerase chain reaction in the amniotic fluid of patients with cervical insufficiency
- Effect of maternal clinical chorioamnionitis on neonatal morbidity in very-low birthweight infants: a case-control study
- The frequency and clinical significance of intra-amniotic infection and/or inflammation in women with placenta previa and vaginal bleeding: an unexpected observation
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- Original articles – Fetus
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- Announcement
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