{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,15]],"date-time":"2026-10-15T16:56:11Z","timestamp":1792083371607,"version":"4.4.0"},"reference-count":27,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2015,4,1]],"date-time":"2015-04-01T00:00:00Z","timestamp":1427846400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2015,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Twin\u2010reversed arterial perfusion (<jats:styled-content style=\"fixed-case\">TRAP<\/jats:styled-content>) sequence affects 1% of monochorionic twin pregnancies and is caused by abnormal vascular connections between a pump twin and an acardiac mass. The effects of abnormal vascular connections on cerebral vasculature in the pump twin are unknown. We hypothesize that abnormal cerebral vascular impedance, as assessed by the pulsatility index (<jats:styled-content style=\"fixed-case\">PI<\/jats:styled-content>), is present in pump twins and that fetal intervention alters cerebral impedance.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Fetal echocardiograms performed between 2010 and 2013 in pregnancies diagnosed with <jats:styled-content style=\"fixed-case\">TRAP<\/jats:styled-content> (<jats:italic>n<\/jats:italic>\u2009=\u200919), recorded at presentation, and uncomplicated monochorionic twin pregnancies (controls, <jats:italic>n<\/jats:italic>\u2009=\u200918; 36 fetuses) were analyzed. In all subjects, the middle cerebral artery (<jats:styled-content style=\"fixed-case\">MCA<\/jats:styled-content>)\u2010<jats:styled-content style=\"fixed-case\">PI<\/jats:styled-content>, combined cardiac output (<jats:styled-content style=\"fixed-case\">CCO<\/jats:styled-content>) and cardiothoracic ratio were calculated, and the values for cases and controls were compared.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The mean gestational age at the time of echocardiography was 20 weeks in both groups. <jats:styled-content style=\"fixed-case\">MCA\u2010PI<\/jats:styled-content> was lower in <jats:styled-content style=\"fixed-case\">TRAP<\/jats:styled-content> cases than in controls (1.55 (95%\u2009<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>, 1.47\u20131.64) <jats:italic>vs<\/jats:italic> 1.74 (95%\u2009<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>, 1.65\u20131.82), respectively; <jats:italic>P<\/jats:italic>\u2009=\u20090.004). <jats:styled-content style=\"fixed-case\">CCO<\/jats:styled-content> in <jats:styled-content style=\"fixed-case\">TRAP<\/jats:styled-content> cases was mildly elevated for gestational age (199.7 (95%\u2009<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>, 138.4\u2013261.1) <jats:styled-content style=\"fixed-case\">mL<\/jats:styled-content>\/min) compared with that of controls (131.4 (95%\u2009<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>, 102.2\u2013160.7) <jats:styled-content style=\"fixed-case\">mL<\/jats:styled-content>\/min). In six <jats:styled-content style=\"fixed-case\">TRAP<\/jats:styled-content> cases with a second echocardiogram available, the mean <jats:styled-content style=\"fixed-case\">MCA\u2010PI<\/jats:styled-content> increased after intervention, from 1.5 (95%\u2009<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>, 1.3\u20131.7) to 1.8 (95%\u2009<jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>, 1.4\u20132.2).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p><jats:styled-content style=\"fixed-case\">TRAP<\/jats:styled-content> pump twins have lower cerebral vascular impedance than do controls, suggestive of a brain\u2010sparing effect. <jats:styled-content style=\"fixed-case\">MCA\u2010PI<\/jats:styled-content> appeared to increase in a small group of pump twins after intervention. These findings suggest a fetal cerebral autoregulatory response to a high cardiac output state that begins to change after fetal intervention. The long\u2010term implications for neurodevelopmental outcome warrant further study. Copyright \u00a9 2014 ISUOG. Published by John Wiley &amp; Sons Ltd.<\/jats:p><\/jats:sec>","DOI":"10.1002\/uog.14650","type":"journal-article","created":{"date-parts":[[2014,8,26]],"date-time":"2014-08-26T10:37:51Z","timestamp":1409049471000},"page":"447-451","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":14,"title":["Twin\u2010reversed arterial perfusion sequence associated with decreased fetal cerebral vascular impedance"],"prefix":"10.1002","volume":"45","author":[{"given":"S.","family":"Peyvandi","sequence":"first","affiliation":[{"name":"Division of Cardiology, Department of Pediatrics University of California San Francisco Benioff Children's Hospital  San Francisco CA USA"},{"name":"The Fetal Treatment Center University of California San Francisco Benioff Children's Hospital  San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"V. A.","family":"Feldstein","sequence":"additional","affiliation":[{"name":"The Fetal Treatment Center University of California San Francisco Benioff Children's Hospital  San Francisco CA USA"},{"name":"Department of Radiology University of California San Francisco  San Francisco CA USA"},{"name":"Department of Obstetrics and Gynecology University of California San Francisco  San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S.","family":"Hirose","sequence":"additional","affiliation":[{"name":"The Fetal Treatment Center University of California San Francisco Benioff Children's Hospital  San Francisco CA USA"},{"name":"Division of Pediatric Surgery, Department of Surgery University of California San Francisco Benioff Children's Hospital  San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"L.","family":"Rand","sequence":"additional","affiliation":[{"name":"The Fetal Treatment Center University of California San Francisco Benioff Children's Hospital  San Francisco CA USA"},{"name":"Department of Obstetrics and Gynecology University of California San Francisco  San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. M.","family":"Brook","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Pediatrics University of California San Francisco Benioff Children's Hospital  San Francisco CA USA"},{"name":"The Fetal Treatment Center University of California San Francisco Benioff Children's Hospital  San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A. J.","family":"Moon\u2010Grady","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Department of Pediatrics University of California San Francisco Benioff Children's Hospital  San Francisco CA USA"},{"name":"The Fetal Treatment Center University of California San Francisco Benioff Children's Hospital  San Francisco CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,4]]},"reference":[{"key":"e_1_2_5_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(90)91094-S"},{"key":"e_1_2_5_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/1096-9926(200011)62:5<356::AID-TERA10>3.0.CO;2-V"},{"key":"e_1_2_5_4_1","doi-asserted-by":"publisher","DOI":"10.1002\/pd.1269"},{"key":"e_1_2_5_5_1","doi-asserted-by":"publisher","DOI":"10.1002\/1097-0223(200008)20:8<615::AID-PD855>3.0.CO;2-9"},{"key":"e_1_2_5_6_1","doi-asserted-by":"publisher","DOI":"10.1196\/annals.1389.023"},{"key":"e_1_2_5_7_1","doi-asserted-by":"crossref","unstructured":"LeeH WagnerAJ SyE BallR FeldsteinVA GoldsteinRB FarmerDL.Efficacy of radiofrequency ablation for twin\u2010reversed arterial perfusion sequence.Am J Obstet Gynecol2007;196:459.e1\u20134.","DOI":"10.1016\/j.ajog.2006.11.039"},{"key":"e_1_2_5_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.13302"},{"key":"e_1_2_5_9_1","doi-asserted-by":"publisher","DOI":"10.1159\/000343223"},{"key":"e_1_2_5_10_1","doi-asserted-by":"publisher","DOI":"10.1159\/000330762"},{"key":"e_1_2_5_11_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.echo.2004.04.011"},{"key":"e_1_2_5_12_1","doi-asserted-by":"publisher","DOI":"10.1515\/JPM.2001.054"},{"key":"e_1_2_5_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.clp.2009.03.014"},{"key":"e_1_2_5_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.6431"},{"key":"e_1_2_5_15_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.5386"},{"key":"e_1_2_5_16_1","doi-asserted-by":"publisher","DOI":"10.1097\/00006250-199203000-00018"},{"key":"e_1_2_5_17_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-002-0404-0"},{"key":"e_1_2_5_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/0002-9378(93)90156-D"},{"key":"e_1_2_5_19_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0378-3782(98)00004-8"},{"key":"e_1_2_5_20_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.9041"},{"key":"e_1_2_5_21_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCIMAGING.109.848432"},{"key":"e_1_2_5_22_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.11144"},{"key":"e_1_2_5_23_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ahj.2012.11.013"},{"key":"e_1_2_5_24_1","doi-asserted-by":"publisher","DOI":"10.1161\/CIRCULATIONAHA.111.064113"},{"key":"e_1_2_5_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jtcvs.2013.06.021"},{"key":"e_1_2_5_26_1","doi-asserted-by":"publisher","DOI":"10.1038\/pr.2013.29"},{"key":"e_1_2_5_27_1","doi-asserted-by":"publisher","DOI":"10.1159\/000295176"},{"key":"e_1_2_5_28_1","doi-asserted-by":"publisher","DOI":"10.1002\/uog.12578"}],"container-title":["Ultrasound in Obstetrics &amp; Gynecology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fuog.14650","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/uog.14650","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,10,5]],"date-time":"2023-10-05T18:24:13Z","timestamp":1696530253000},"score":1,"resource":{"primary":{"URL":"https:\/\/obgyn.onlinelibrary.wiley.com\/doi\/10.1002\/uog.14650"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2015,4]]},"references-count":27,"journal-issue":{"issue":"4","published-print":{"date-parts":[[2015,4]]}},"alternative-id":["10.1002\/uog.14650"],"URL":"https:\/\/doi.org\/10.1002\/uog.14650","archive":["Portico"],"relation":{},"ISSN":["0960-7692","1469-0705"],"issn-type":[{"value":"0960-7692","type":"print"},{"value":"1469-0705","type":"electronic"}],"subject":[],"published":{"date-parts":[[2015,4]]},"assertion":[{"value":"2014-06-05","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2014-08-13","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2015-04-01","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}