Anesthetic management of conjoined twins presenting for palliative open-heart surgery.
A set of dicephalous parapagus twins was born at 36 wk gestational age. Twin A had complex congenital heart disease in the form of a single ventricle that would be fatal without surgical intervention. Twin B had normal intracardiac anatomy. The twins were deemed surgically inseparable and the parents requested palliative open-heart surgery on Twin A. The twins shared a common circulatory system to the lower half of the body so that physiological manipulations in one twin adversely affected the other's hemodynamic condition. Twin A underwent successful single ventricle palliation; however, after a prolonged hospitalization, the infants died secondary to severe respiratory disease in Twin B.
Division of Cardiovascular Anesthesia, Congenital Heart Institute of Miami Children's Hospital and Arnold Palmer Hospital for Children & Women, Florida 33155, USA. christopher.tirotta@mch.com
Christopher F
CF
Tirotta
Richard
R
Lagueruela
Hamish M
HM
Munro
Evan M
EM
Zahn
Leo
L
Lopez
Redmond P
RP
Burke
D000758:Anesthesia; D006348:Cardiac Surgical Procedures; D002315:Cardiopulmonary Bypass; D004374:Ductus Arteriosus, Patent / Q000503:physiopathology; D017809:Fatal Outcome; D005260:Female; D006228:Hand Deformities, Congenital / Q000601:surgery; D006352:Heart Ventricles / Q000002:abnormalities / Q000601:surgery; D006801:Humans; D007223:Infant; D010166:Palliative Care; D014428:Twins, Conjoined / Q000601:surgery*