[Cardiovascular diagnosis in thoracopagus twins]

Area of Science:

• Cardiology
• Pediatric Surgery
• Medical Imaging

Background:

• Conjoined twins present complex surgical scenarios, particularly when sharing cardiac structures.
• Thoracopagus and thoracoischiopagus twins with cardiac connections require specialized diagnostic and surgical approaches.

Observation:

• Two cases are presented: a thoracopagus with atrial and ventricular connections and a thoracoischiopagus with atrial connection and multiple cardiac defects.
• Electrocardiography (ECG), radionuclid studies, and computed tomography (CT) offer limited value in assessing cardiac fusion.
• Angiocardiography is essential for precise classification of cardiac fusion, categorizing twins into pericardial union, venae-cavae/atrial connection, or ventricular connection.

Findings:

• Separation of conjoined twins with only pericardial fusion is frequently successful.
• Successful separation of conjoined twins with atrial fusion is exceptionally rare, with only one prior report.
• There are no reported successful separations of conjoined twins with ventricular fusion.

Implications:

• Accurate pre-operative assessment via angiocardiography is critical for surgical planning and determining the feasibility of separation.
• The findings highlight the extreme difficulty and rarity of separating conjoined twins with significant cardiac connections, especially ventricular fusion.
• Further research into surgical techniques and improved imaging modalities is warranted for managing these complex congenital anomalies.