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Conjoined hearts in thoracopagus twins
R Thomas Collins1, Paul M Weinberg, Peter J Gruber
1Division of Cardiology, Arkansas Children's Hospital, Little Rock, AR 72202, USA. rtcollins@uams.edu
Pediatric Cardiology
|January 25, 2012
Summary
Separating conjoined hearts in thoracopagus twins is extremely difficult due to severe cardiac abnormalities. Most conjoined twins have major congenital heart disease, often with single ventricles, leading to poor outcomes and suggesting palliative care.
Area of Science:
- Cardiology
- Pediatric Surgery
- Medical Genetics
Background:
- Conjoined twins present complex surgical challenges, particularly when sharing cardiac structures.
- Thoracopagus twins with conjoined hearts require specialized evaluation to determine surgical feasibility.
Purpose of the Study:
- To identify cardiac abnormalities in conjoined twins that impede successful surgical separation.
- To analyze the outcomes of thoracopagus conjoined twins with conjoined hearts.
Main Methods:
- Retrospective review of consecutive thoracopagus conjoined twins with conjoined hearts.
- Analysis of autopsy, surgical findings, and clinical reports from 1980-2008.
- Evaluation of cardiac anatomy, including presence of major congenital heart disease and single-ventricle physiology.
Main Results:
- Nine sets of conjoined twins were reviewed (mean gestational age 33.8 weeks).
- Major congenital heart disease affected 94.4% of hearts; 72.2% had single-ventricle physiology.
- Total anomalous pulmonary venous return occurred in 39% of cases, with high mortality.
Conclusions:
- The inability to separate conjoined and single ventricles results in a poor clinical outcome for thoracopagus twins.
- Surgical nonintervention and palliative care should be strongly considered for these complex cases.
- Understanding specific cardiac structural abnormalities is crucial for managing conjoined twins.
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