Saturday, January 31, 2009

More interesting times in Oklahoma

Just wanted to share a great news article we had here in Oklahoma. A pair of conjoined twins were separated! I believe these girls are thoraco-omphalopagus conjoined twins. I got to see their heart catherization on my cardiology rotation. Fascinating!
Here's the article:
http://www.oumedcenter.com/body.cfm?id=2601
and pictures:
http://www.oumedcenter.com/body.cfm?ID=2602

9 comments:

Mr. Baker said...

Ok Dr. Samara, please define thoraco-omphalopagus conjoined. I am assuming that each had her own heart but I am guessing that there might have been some sharing of the lungs. Facinating, and keep us informed.

Shauna said...

So their lungs were connected? ..how does that work with the chest cavity?

Bulgan said...

what does thoraco-omphalopagus conjoined twins mean? and when they were born, they had two hearts and other organs right?

Samara Peters said...

Thoraco-omphalopagus twins are twins that are conjoined twins that are connected from the mid-breast bone (thoraco-) to the belly button (omphalo-), pagus is the suffix for conjoined twins. These types of conjoined twins usually have separate hearts and lungs since it is just the mid-section of the chest where they are joined (after the division of where the heart and lungs bud off embryologically). These types of conjoined twins can be complicated with shared livers (as in this case) and shared intestines/digestive tracts (fortunately, not this case). Incidentally, I believe one of these twins is dextrocardiac--her heart points to her right side instead of her left!

Cintia said...

Samara P. or Mr. Baker:

-ok, is it Preslee that is more likely to have the heart pointing to the right?
-Do these type of new born twins that are conjoined later on in life most likely to have breathing problems? or any other critical problems?

Mr. Baker said...

Thanks for the update Samara. It sounds as though the twins their situation could have been more difficult. I would like to second Cintia's question about their future. What kind of challenges will they face?

Bulgan said...

Is it possible to have heart at the right side? How so? Now this is leading me to search more about hearts.

Samara Peters said...

Heart pointing to the right question:
This was a long conversation after looking at the heart catheterizations, using dolls to simulate each little girl. If I remember correctly, the girls had one side that was slightly more exposed, so they were actually connected at an angle instead of exactly face-to-face. And it was the girl on the left that was thought to have dextrocardia because the hearts extended forward into the shared chest area, but the girl on the left had a heart behind the girl on the right. This makes alot more sense with visual aids--it's difficult to explain in just words.

Future complications for the conjoined twins:
The complications obviously will mostly affect the parts of the body that were shared--in this case, the chest wall, abdominal wall and liver.
The liver is really an amazing organ in that it can regenerate itself spontaneously. So, that is probably the least of these girls' worries. Their hearts had good function prior to the surgery, unless something changed (which is entirely possible, but has not been reported). The biggest problems with any child in critical care is ventilation--making sure they breathe. Since they were connected lower on their sternums, only part of their chest wall was compromised. Initial concerns were that, even though they shared part of a chest cavity, the control over their portion was independent--so one girl could be trying to inhale as the other was exhaling. How complicated! Currently, both girls are on ventilators to assist thier breathing and one had to be placed on ECMO (essentially a machine that does the job for the lungs) for a short period of time. Only time will tell how good their lungs become. It's a very long, stressful waiting game.

Is it possible to have a heart on the right side?
Absolutely. It is extremely rare, however. You can have independent dextrocardia (where it's just your heart on the wrong side) or full situs inversus (when everything is on the wrong side--heart, liver, stomach, intestines) (look up Kartagener's syndrome!). People with just dextrocardia can be mostly normal--there's some lung issues usually. People with Kartagener's syndrome usually have major problems, including lung issues and infertility.

Cintia said...

Thank You for answering my question Samara