When the Heart Beats for Two. Twin Reversed Arterial Prefusion (case reports)
DOI: 10.32364/2618-8430-2025-8-3-10
P.A. Kuznetsov1, M.A. Ponimanskaya2, K.A. Desyatnik2, S.Z. Sanaya2, M.O. Matveev2, Yu.A. Popyonova2, A.V. Tyagunova1, A.V. Putrya1, L.Ya. Abbasova1, A.I. Lovkova3, D.A. Fedyaev4
1Pirogov Russian National Research Medical University, Moscow, Russian Federation
2L.A. Vorokhobov City Clinical Hospital No. 67, Moscow, Russian Federation
3Lomonosov Moscow State University, Moscow, Russian Federation
4N.V. Sklifosovskiy Research Institute for Emergency Medical Aid, Moscow, Russian Federation
Twin reversed arterial perfusion is one of rare and severe forms of monochoric multiple pregnancy when one of the twins (fetus acardius) depends on blood supply of the other (donor fetus) through malformed placental vessels. As a result, the fetus acardius receives oxygen-depleted blood. In turn, this leads to significant anatomical and physiological disorders preventing normal independent development of the fetus. Fetus acardius is a rare but significant abnormality in obstetric practice, as it is a specific complication of monochoric multiple pregnancy. To date, according to the world literature, there is no a common standard treatment of twin reversed arterial perfusion. However, advanced diagnostic methods such as ultrasonography and dopplerometry provide timely detection of the abnormality and decision-making about pregnancy management tactics to reduce perinatal risks. Specific interventions to manage blood circulation between twins increase odds for a favorable outcome in a donor fetus. Further studies of a mechanism of development of a fetus acardius will help not only to understand causes of the malformation better, but also to improve methods of its diagnosis and treatment. The paper provides an overview of world literature data, fetus acardius classifications, and potential pathogenesis of the disease. Moreover, it highlights clinical manifestations, diagnostic approaches and treatment strategy, two own case reports.
Keywords: fetus acardius, monochorionic monoamniotic twins, monochorionic diamniotic twins, twin reversed arterial perfusion, placenta, acardial chorioangiopagus parasitism, acardial malformation, endoscopic laser coagulation of umbilical cord vessels.
For citation: Kuznetsov P.A., Ponimanskaya M.A., Desyatnik K.A., Sanaya S.Z., Matveev M.O., Popyonova Yu.A., Tyagunova A.V., Putrya A.V., Abbasova L.Ya., Lovkova A.I., Fedyaev D.A. When the Heart Beats for Two. Twin Reversed Arterial Prefusion (case reports). Russian Journal of Woman and Child Health. 2025;8(3):241–247 (in Russ.). DOI: 10.32364/2618-8430-2025-8-3-10
About the authors:
Pavel A. Kuznetsov — C. Sc. (Med.), Assistant Professor of the Department of Obstetrics and Gynecology, Institute of Surgery, Pirogov Russian National Research Medical University; 1, Ostrovityanov str., Moscow, 117513, Russian Federation; ORCID iD 0000-0003-2492-3910
Maria A. Ponimanskaya — C. Sc. (Med.), Deputy Chief Physician for Obstetric and Gynecological Care, L.A. Vorokhobov City Clinical Hospital No. 67; 2/44, Salyam Adil str., Moscow, 123423, Russian Federation; ORCID iD 0000-0001-9447-110X
Kirill A. Desyatnik — Obstetrician-Gynecologist, Head of the Obstetric Department of Pregnancy Failure No. 1, Perinatal Center of L.A. Vorokhobov City Clinical Hospital No. 67; 2/44, Salyam Adil str., Moscow, 123423, Russian Federation; ORCID iD 0000-0001-6758-2605
Sevastina Z. Sanaya — Obstetrician-Gynecologist, Obstetric Department of Pregnancy Failure No. 1, Perinatal Center of L.A. Vorokhobov City Clinical Hospital No. 67; 2/44, Salyam Adil str., Moscow, 123423, Russian Federation; ORCID iD 0000-0001-8289-3380
Maksim O. Matveev — Obstetrician-Gynecologist, Obstetric Department of Pregnancy Failure No. 1, Perinatal Center of L.A. Vorokhobov City Clinical Hospital No. 67; 2/44, Salyam Adil str., Moscow, 123423, Russian Federation; ORCID iD 0000-0003-2431-1615
Yuliya A. Popyonova — Obstetrician-Gynecologist, Obstetric Department of Pregnancy Failure No. 1, Perinatal Center of L.A. Vorokhobov City Clinical Hospital No. 67; 2/44, Salyam Adil str., Moscow, 123423, Russian Federation; ORCID iD 0009-0005-8789-600X
Anna V. Tyagunova — C. Sc. (Med.), Associate Professor of the Department of Obstetrics and Gynecology, Institute of Surgery, Pirogov Russian National Research Medical University; 1, Ostrovityanov str., Moscow, 117513, Russian Federation; ORCID iD 0000-0001-7836-6369
Anna V. Putrya — 1st-year Clinical Resident at the Department of Obstetrics and Gynecology, Institute of Surgery, Pirogov Russian National Research Medical University; 1, Ostrovityanov str., Moscow, 117513, Russian Federation; ORCID iD 0009-0003-6628-3357
Leila Ya. Abbasova — 1st-year Clinical Resident at the Department of Obstetrics and Gynecology, Institute of Surgery, Pirogov Russian National Research Medical University; 1, Ostrovityanov str., Moscow, 117513, Russian Federation; ORCID iD 0009-0006-1701-8620
Anna I. Lovkova — 1st-year Clinical Resident at the Department of Obstetrics and Gynecology, Faculty of Fundamental Medicine, Lomonosov Moscow State University; 27, bld. 1, Lomonosovskyi ave., Moscow, 119991, Russian Federation, ORCID iD 0009-0006-9215-3750
Denis A. Fedyaev — 1st-year Clinical Resident specializing in cardiovascular surgery, N.V. Sklifosovskiy Research Institute for Emergency Medical Aid; 3, Bolshaya Sukharevskaya sq., Moscow, 129090, Russian Federation; ORCID iD 0009-0009-7172-3496
Contact information: Pavel A. Kuznetsov, e-mail: poohsmith@mail.ru
Financial Disclosure: no authors have a financial or property interest in any material or method mentioned.
There is no conflict of interest.
Received 02.06.2025.
Revised 27.06.2025.
Accepted 22.07.2025.
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