Separation of thoracopagus conjoined twins. A case report.
A pair of thoracopagus conjoined twins with a connection at the atrioventricular groove of both hearts and a huge conjoined liver were surgically separated. An aortopulmonary shunt was created for Twin B, a victim of complex congenital heart disease with hypoplastic right heart syndrome, who died 5 hours later. However, Twin A survived after prolonged endotracheal intubation and parenteral nutrition. He survived for 7 months, and went home, but finally died of sepsis. In reviewing 47 pairs of surgically separated thoracopagus conjoined twins, in 30 pairs of type A (Leachman's classification, completely separate hearts), 42 patients survived (70%); in 5 pairs of type B (atrial connection only), one patient survived (10%); in 9 pairs of type C (both atrial and ventricular interconnections), none survived; in 3 pairs of unknown type, 2 survived. Total survival rate of surgically separated thoracopagus conjoined twins was 47.9%. The survival rate was 38.2% in those operated in the neonatal period (n = 34) and 63.6% in those operated over 1 month of age (n = 44) (p = 0.016). In conclusion, thoracopagus conjoined twins are rare. Although its separation carries a high risk, especially in those with cardiac connection, this report confirmed that separation is still feasible under proper preparation and planning.
Chiu
C T
CT
Department of Surgery, College of Medicine, National Taiwan University, Taipei, Rep. of China.
Hou
S H
SH
Lai
H S
HS
Lee
P H
PH
Lin
F Y
FY
Chen
W J
WJ
Chen
M T
MT
Lin
T W
TW
Chu
S H
SH
D004562:Electrocardiography; D017809:Fatal Outcome; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000473:pathology / Q000601:surgery; D006801:Humans; D007223:Infant; D008099:Liver / Q000002:abnormalities; D008279:Magnetic Resonance Imaging; D008297:Male; D008722:Methods; D014057:Tomography, X-Ray Computed; D014428:Twins, Conjoined / Q000473:pathology / Q000601:surgery*