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A common explanation for this disruption is hypoxia\u2010ischemia due to twin reversed arterial perfusion (TRAP). In this condition, arterial\u2013arterial and venous\u2013venous anastomoses in the placenta permit twin\u2013twin transfusion and reversal of blood flow in the umbilical vessels and aorta of the recipient twin. The heart is absent or severely deficient, either by secondary atrophy or possibly a more primary, though currently unknown, mechanism. As a result, cranial tissues are less likely to be perfused with oxygenated blood than caudal tissues. A host of craniocerebral anomalies are observed in acardia, including total absence of the head and brain, rudimentary brain, anencephaly, holoprosencephaly, neuronal migration defects, and near\u2010normal brain. Hypoxia\u2010ischemia could be an important factor in the disruption of tissues in the present case, although a more generalized process affecting heart, head, and brain cannot be excluded. The findings suggest that hypoxia\u2010ischemia may play a role in the pathogenesis of some cases of holoprosencephaly and aprosencephaly. This mechanism has been underreported and requires additional investigation. \u00a9 2007 Wiley\u2010Liss, Inc.<\/jats:p>","DOI":"10.1002\/ajmg.a.32027","type":"journal-article","created":{"date-parts":[[2007,11,14]],"date-time":"2007-11-14T01:16:30Z","timestamp":1195002990000},"page":"3100-3106","source":"Crossref","is-referenced-by-count":9,"title":["Cyclopia, aprosencephaly, and acardiac twinning: Is hypoxia\u2010ischemia a unifying mechanism?"],"prefix":"10.1002","volume":"143A","author":[{"given":"Joseph 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