Cardiovascular anomalies in thoracopagus twins and the importance of preoperative cardiac evaluation.

Abstract

Four pairs of thoracopagus twins have been described. Cardiac catheterisation was performed in all the cases. Angiocardiographic and necropsy findings suggest that the most common abnormality was some form of univentricular heart. The communication between the 2 hearts was at atrial level in 2 cases. Separation was performed in 1 of these cases but only 1 of the twins survived for 14 hours after operation. It is suggested that full cardiac catheterisation with selective angiocardiogram is essential before separation is considered. Identical heart rates were observed in each pair and there was invariably a major communication between the hearts of the twins.

Cardiovascular Malformations in Lecanosomatopagus Conjoined Twins: A Cardiologic Curiosity

“…The cardiovascular defects found in the lecanosomatopagus conjoined twins we studied were similar to those described in the majority of thoracopagus twins [2,3]. The feasibility of a surgical separation of thoracopagus twins strongly depends on the extent of the conjunction of the heart and the severity of the present cardiac malforma tions; for this reason the anatomy of the car diovascular system is first investigated in their evaluation [4].…”

Cardiac catheterization in diagnosis and management of congenital heart disease in thoracopagus conjoined twins

“…Over the last two decades, several modalities have become available in addition to angiography in determining the degree of cardiac involvement, including prenatal and postnatal echocardiography and MRI. There have only been isolated case reports of angiography as a diagnostic tool in conjoined twins, prompting us to report our experience [5,[12][13][14][15][16].…”

“…Catheterization was not completed until the degree of atrial and ventricular fusion, the number and morphology of the atrioventricular valves, the number and morphology of the ventricles, the number and relationship of the great vessels, and the systemic and pulmonary venous drainage of both twins had been answered (Figs. [2][3][4][5][6][7][8]. At least one angiogram was performed in the inferior vena cava/hepatic vein (to delineate the degree of liver union and hepatic vein course), the SVC, the atrium, one or both ventricles, the pulmonary artery and aorta of each twin, unless angiography in the corresponding twin had fully elucidated the anatomy in the opposite twin (i.e., fused cardiac components).…”

“…Surgical separation of thoracopagus twins has become increasingly feasible with the significant advances made in the last decade by multidisciplinary teams, including general surgical, orthopedic, plastic, urology, and cardiac teams in both preoperative evaluation and postoperative care. The degree of cardiac involvement is usually the limiting factor for successful separation in thoracopagus twins, particularly without sacrificing one of the twins [5][6][7]. One of the crucial components of preoperative evaluation is the accurate delineation of cardiac anatomy.…”

Prenatal ultrasonographic diagnosis of thoracopagus conjoined twins

“…Once the diagnosis is made, is important to establish the extent of conjoining, since survival depends on the site of union and the resultant fusion of vital organs. In all documentated cases of thoracopagus twins the liver is found to be common, with a common peri-to the cardiac structures since fetal prognosis cardial sac in 90%, a fusioned heart in 75% and depends mainly on severity of fusion and anoma common gastrointestinal tract in 50% [5,7, alies of the hearts [5,15]. However, a complete 15].…”