Prenatal ultrasonographic diagnosis of acardiac twin

Acardiac twinning is a rare complication of monozygotic twin gestation occurring in 1/35,000 pregnancies or in 1% of all monozygotic twins. This condition is characterized by partial or complete lack of development of the heart in one of the twins, and requires that the normal twin (pump twin) provides circulation for itself as well as the acardiac sibling (perfused twin) by means of reverse circulation through large artery-to-artery and vein-to-vein anastomoses. The acardiac anomaly is uniformly fatal for the perfused twin, and the perinatal mortality for the normal twin is about 50%, usually as the result of congestive heart failure, polyhydramnios, and preterm delivery. In this report we present two cases of acardiac twin prenatally diagnosed by ultrasound. The principal sonographic features for prenatal diagnosis and the clinical management are briefly discussed.