Acardia

Definition

Acardia is a very rare, serious malformation that occurs almost exclusively in monozygous twins (twins developing from a single egg). This condition results from artery to artery connections in the placenta causing a physically normal fetus to circulate blood for both itself and a severely malformed fetus whose heart regresses or is overtaken by the pump twin's heart.

Description

Acardia was first described in the sixteenth century. Early references refer to acardia as chorioangiopagus parasiticus. It is now also called twin reversed arterial perfusion sequence, or TRAP sequence.

Mechanism

Acardia is the most extreme form of twin-twin transfusion syndrome. Twin-twin transfusion syndrome is a pregnancy complication in which twins abnormally share blood flow from the umbilical artery of one twin to the umbilical vein of the other. This abnormal connection can cause serious complications including loss of the pregnancy.

In acardiac twin pregnancies, blood vessels abnormally connect between the twins in the placenta. The

placenta is the important interface of blood vessels between a mother and baby through which babies receive nutrients and oxygen. This abnormal connection forces the twin with stronger blood flow to pump blood for both, straining the heart of this "pump" twin. This abnormal connection causes the malformed twin to receive blood directly from the pump twin before this blood gathers new oxygen. The poorly deoxygenated blood from the normal twin as well as the pressure deficiency as a result of trying to serve both infants may be the cause of the other twin's malformations.

The acardiac twin

The acardiac twin is severely malformed and may be incorrectly referred to as a tumor. In 1902, a physician named Das established four categories of acardiac twins based on their physical appearance. There is controversy surrounding the use of these traditional four categories because some cases are complex and do not fit neatly into one of Das's four categories. These four traditional categories include acardius acephalus, amorphus, anceps, and acormus.

Acardius acephalus is the most common type of acardiac twin. These twins do not develop a head, but may have an underdeveloped skull base. They have legs, but do not have arms. On autopsy they are generally found to lack chest and upper abdominal organs.

Acardius amorphus appears as a disorganized mass of tissues containing skin, bone, cartilage, muscle, fat, and blood vessels. This type of acardiac twin is not recognizable as a human fetus and contains no recognizable human organs.

Acardius anceps is the most developed form of acardiac twin. This form has arms, legs, and a partially developed head with brain tissues and facial structures. This type of acardiac twin is associated with a high risk for complications in the normal twin.

Acardius acormus is the rarest type of acardiac twin. This type of acardiac twin presents as an isolated head with no body development.