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PubMed · 7428769

The acardiac monster.

R Lachman·M McNabb·M Furmanski·L Karp
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Abstract

Two cases of acardiac fetuses are presented. Pathological data in 61 cases are tabulated. Cliassification, terminology and patho-physiological findings are discussed. The Acardiac Monster is a form of monozygotic multiple gestation lacking a physiological heart and resulting in a bizarre fetal malformation which is sustained in utero by parasitic anastomoses to the circulation of a normal twin fetus. The precise etiology of this phenomenon is still obscure and suggestions are made for the future evaluation of the acardiac fetus.

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Abnormalities, Severe TeratoidAbortion, SpontaneousAdolescentFemaleHumansPregnancyRadiographyTwins, MonozygoticCase ReportsJournal Article

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R Lachman, M McNabb, M Furmanski, L Karp. 1980. The acardiac monster.. https://doi.org/10.1007/bf00441472

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An acardiac twin pregnancy is a rare but serious complication of monochorionic twinning and consists of an acardiac twin and a pump twin. The acardiac twin is a severely malformed fetus that lacks most organs, particularly a heart, but grows during pregnancy because it is perfused by the developmentally normal pump twin via a set of arterioarterial and venovenous placental anastomoses. Pump twins die intrauterine or neonatally in about 50% of the cases. Because the effects of an acardiac mass on the pump twin's development are incompletely known, methods for outcome prognosis are currently not available. We sought to derive simple relations for the pump twin's excess cardiac output and decreased oxygenation and to use available clinical cases for a preliminary test of the model. As a method, we used a theoretical flow model to represent the fetoplacental circulation of an acardiac twin pregnancy and estimated blood deoxygenation and reoxygenation following perfusion of the two bodies and placentas, respectively. The results show the pump twin's excess cardiac output and decrease of venous oxygen saturation to depend on the ratio of pump twin to acardiac twin umbilical blood flow, whose ratio can be measured by ultrasonography. The clinical cases show a decreasing umbilical flow ratio with gestation. In conclusion, prospective serial study is necessary to test whether measurement of umbilical flow ratios allows monitoring the pump twin's pathophysiologic development, possibly resulting in a guideline for prognosis of pump twin survival.

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