Skip to main content
Top
Published in: Pediatric Cardiology 1/2006

01-02-2006 | Review

Congenital Heart Defects in Conjoined Twins: Outcome After Surgical Separation of Thoracopagus

Authors: C. J. McMahon, R. Spencer

Published in: Pediatric Cardiology | Issue 1/2006

Login to get access

Abstract

In this study, we correlated cardiac malformations in the various types of conjoined twins with the proposed site of embryologic union and evaluated the possibility of survival after surgical separation. We conclude that surgical separation is only very rarely successful in twins with united hearts, whereas survival in twins with separate hearts is more dependent on the malformations of other viscera. This report deals primarily with conjoined twins in whom anomalies of the heart are the major factor in deciding whether surgical separation is feasible.
Footnotes
1
The details of these cases, as collected from > 1200 cases, reviewed in Spencer R (2003) Conjoined twins: developmental malformations and (clinical implications, The Johns Hopkins University Press, Baltimore (MD).
 
Literature
1.
go back to reference Amiel, GJ 1967Conjoined entire twins: a case of thoraco-omphalopagus with discussion on nomenclature, obstetrical management, and anatomical noteBr J Clin Pract21141146PubMed Amiel, GJ 1967Conjoined entire twins: a case of thoraco-omphalopagus with discussion on nomenclature, obstetrical management, and anatomical noteBr J Clin Pract21141146PubMed
3.
go back to reference Antonelli, D, Avni, G, Antonelli, G, et al. 1989Cardiovascular malformations in lecanosomatopagus conjoined twins, a cardioplegic curiosityCardiology766770CrossRefPubMed Antonelli, D, Avni, G, Antonelli, G,  et al. 1989Cardiovascular malformations in lecanosomatopagus conjoined twins, a cardioplegic curiosityCardiology766770CrossRefPubMed
4.
go back to reference Bankl, H 1971Thorakopagus mit gemeinsamen misgebildetem HerzenPediatr Padol6309312 Bankl, H 1971Thorakopagus mit gemeinsamen misgebildetem HerzenPediatr Padol6309312
5.
go back to reference Barford, DAG 1976Delivery of Siamese twins by cesarean sectionS Afr Med J5019821983PubMed Barford, DAG 1976Delivery of Siamese twins by cesarean sectionS Afr Med J5019821983PubMed
6.
go back to reference Baron, BW, Shermeta, DW, Ismail, MA, et al. 1990Unique anomalies in a cephalothoracopagus janiceps conjoined twin with implications for multiple mechanisms in the abnormal embryogenesisTeratology41922CrossRefPubMed Baron, BW, Shermeta, DW, Ismail, MA,  et al. 1990Unique anomalies in a cephalothoracopagus janiceps conjoined twin with implications for multiple mechanisms in the abnormal embryogenesisTeratology41922CrossRefPubMed
7.
go back to reference Berry, RJA 1904The anatomical variations presented by two twin monstersJ Obstet Gynaecol Br Emp5217229CrossRef Berry, RJA 1904The anatomical variations presented by two twin monstersJ Obstet Gynaecol Br Emp5217229CrossRef
8.
go back to reference Bloch, EC, Kares, JH 1980Cardiopagus in neonatal thoracopagus twins: anesthetic managementAnesth Analg59304307CrossRefPubMed Bloch, EC, Kares, JH 1980Cardiopagus in neonatal thoracopagus twins: anesthetic managementAnesth Analg59304307CrossRefPubMed
9.
go back to reference Brown, DL, Holubec, DM, Towle, DJ, et al. 1985Anesthetic management of thoracopagus twins undergoing cardiopagus separationAnesthesiology62679682CrossRefPubMed Brown, DL, Holubec, DM, Towle, DJ,  et al. 1985Anesthetic management of thoracopagus twins undergoing cardiopagus separationAnesthesiology62679682CrossRefPubMed
10.
go back to reference Chaurasia, BD 1975Abnormal umbilical vessels and systemic circulatory reversal in thoracopagus twinsAda Genet Med Gemellol24261268CrossRef Chaurasia, BD 1975Abnormal umbilical vessels and systemic circulatory reversal in thoracopagus twinsAda Genet Med Gemellol24261268CrossRef
11.
go back to reference Chiu, CT, Hou, SH, Lai, HS, et al. 1994Separation of thoracopagus conjoined twins: a case reportJ Cardiovasc Surg35459462 Chiu, CT, Hou, SH, Lai, HS,  et al. 1994Separation of thoracopagus conjoined twins: a case reportJ Cardiovasc Surg35459462
12.
go back to reference Cohen, HL, Shapiro, ML, Haller, JO, Schwartz, D 1992The multivessel umbilical cord: an antenatal indicator of possible conjoined twinningJ Clin Ultrasound20278282CrossRefPubMed Cohen, HL, Shapiro, ML, Haller, JO, Schwartz, D 1992The multivessel umbilical cord: an antenatal indicator of possible conjoined twinningJ Clin Ultrasound20278282CrossRefPubMed
13.
go back to reference Leon, F 1974Siamesische Zwillinge mit differenten HermissbildungenVirchows Arch Pathol Anat3625157CrossRefPubMed Leon, F 1974Siamesische Zwillinge mit differenten HermissbildungenVirchows Arch Pathol Anat3625157CrossRefPubMed
14.
go back to reference Dev, V, Pothineni, RB, Rohatgi, M, Shrivastava, S 1990Echo-Doppler assessment of cardiac status in conjoined (thoraco-omphalopagus) twinsPediatr Cardiol119192CrossRefPubMed Dev, V, Pothineni, RB, Rohatgi, M, Shrivastava, S 1990Echo-Doppler assessment of cardiac status in conjoined (thoraco-omphalopagus) twinsPediatr Cardiol119192CrossRefPubMed
15.
go back to reference Doski, JJ, Heiman, HS, Solenberger, RI, et al. 1997Successful separation of ischiopagus tripus conjoined twins with comparative analysis of methods for abdominal wall closure and use of tripus limbJ Pediatr Surg3217611766CrossRefPubMed Doski, JJ, Heiman, HS, Solenberger, RI,  et al. 1997Successful separation of ischiopagus tripus conjoined twins with comparative analysis of methods for abdominal wall closure and use of tripus limbJ Pediatr Surg3217611766CrossRefPubMed
16.
go back to reference Edgar, J, Lindsay, J 1904A double monster: case of thoracopagusGlasgow Med J61302306 Edgar, J, Lindsay, J 1904A double monster: case of thoracopagusGlasgow Med J61302306
17.
18.
go back to reference Fowler, O 1898Double monster of the dicephalus typeTrans Obstet Soc London4011 Fowler, O 1898Double monster of the dicephalus typeTrans Obstet Soc London4011
19.
go back to reference Freyschmidt, HJ 1932Uber zwei doppelmissbildungen (Sternopagus und Dizephalus)Monatsschr Geburtschilfe Gynakol90429441 Freyschmidt, HJ 1932Uber zwei doppelmissbildungen (Sternopagus und Dizephalus)Monatsschr Geburtschilfe Gynakol90429441
20.
go back to reference Gerlis, L, Seo, JW, Ho, SY, Chi, JEG 1993Morphology of the cardiovascular system in conjoined twins: spatial and sequential segmental arrangements in 36 casesTeratology4791108CrossRefPubMed Gerlis, L, Seo, JW, Ho, SY, Chi, JEG 1993Morphology of the cardiovascular system in conjoined twins: spatial and sequential segmental arrangements in 36 casesTeratology4791108CrossRefPubMed
21.
go back to reference Gilbert, EF, Suzuk, H, Kimmel, DL, et al. 1972A case of thoracopagus twins: conjoined twinsTeratology6197200CrossRefPubMed Gilbert, EF, Suzuk, H, Kimmel, DL,  et al. 1972A case of thoracopagus twins: conjoined twinsTeratology6197200CrossRefPubMed
22.
go back to reference Golladay, ES, Wiliams, GD, Seibert, JJ, et al. 1982Dicephalus dipus conjoined twins: a surgical separation and review of previously reported casesJ Pediatr Surg17259264CrossRefPubMed Golladay, ES, Wiliams, GD, Seibert, JJ,  et al. 1982Dicephalus dipus conjoined twins: a surgical separation and review of previously reported casesJ Pediatr Surg17259264CrossRefPubMed
24.
go back to reference Ilberg, G 1939Bin Fall von Thoracopagus mit cor biloculareZ Geburtshilfe Gynaekol119369397 Ilberg, G 1939Bin Fall von Thoracopagus mit cor biloculareZ Geburtshilfe Gynaekol119369397
25.
go back to reference Izukawa, T, Kidd, BSL, Moes, CAF, et al. 1978Assessment of the cardiovascular system in conjoined thoracopagus twinsAm J Dis Child1321924PubMed Izukawa, T, Kidd, BSL, Moes, CAF,  et al. 1978Assessment of the cardiovascular system in conjoined thoracopagus twinsAm J Dis Child1321924PubMed
26.
go back to reference Jenkins, EW, Watson, TR, Mosenthall, WT 1958Surgery in conjoined twinsArch Surg763540CrossRef Jenkins, EW, Watson, TR, Mosenthall, WT 1958Surgery in conjoined twinsArch Surg763540CrossRef
27.
go back to reference Johnson, NJ, Doherty, JE 1957Simultaneous electrocardiograms in thoracopagus twinsAm Heart J53151156 Johnson, NJ, Doherty, JE 1957Simultaneous electrocardiograms in thoracopagus twinsAm Heart J53151156
28.
go back to reference Kamann, K 1903Zwei Falle von Thoracopagus tetrabrachiusArch Gynaecol68661677CrossRef Kamann, K 1903Zwei Falle von Thoracopagus tetrabrachiusArch Gynaecol68661677CrossRef
29.
30.
go back to reference Kelekis, L, Kelekis, D, Mameletzis, K, et al. 1980Thoracopagus twins studied with computed tomographyJ Comput Assist Tomogr4405406CrossRefPubMed Kelekis, L, Kelekis, D, Mameletzis, K,  et al. 1980Thoracopagus twins studied with computed tomographyJ Comput Assist Tomogr4405406CrossRefPubMed
31.
go back to reference Kim, CK, Barr, RJ, Benirschke, K 1971Cytogenetic studies of conjoined twinsObstet Gynecol38877881PubMed Kim, CK, Barr, RJ, Benirschke, K 1971Cytogenetic studies of conjoined twinsObstet Gynecol38877881PubMed
32.
go back to reference Krankendonk, GH 1963A thoracopagus with unusual cardiac anomaliesActa Morphol Neerl Scand5235244 Krankendonk, GH 1963A thoracopagus with unusual cardiac anomaliesActa Morphol Neerl Scand5235244
33.
go back to reference Marchinski, A, Lopatec, HU, Wermenski, K, et al. 1978Angiographic evaluation of conjoined twinsPediatr Radiol6230232CrossRef Marchinski, A, Lopatec, HU, Wermenski, K,  et al. 1978Angiographic evaluation of conjoined twinsPediatr Radiol6230232CrossRef
34.
go back to reference Marin-Padilla, M, Chin, AJ, Marin-Padilla, TM 1981Cardiovascular abnormalities in thoracopagus twinsTeratology23101113CrossRefPubMed Marin-Padilla, M, Chin, AJ, Marin-Padilla, TM 1981Cardiovascular abnormalities in thoracopagus twinsTeratology23101113CrossRefPubMed
35.
go back to reference Mathewson, J, Waldman, J, George, L, et al. 1984shared coronary arteries and coronary venous drainage in thoracopagus twinsJ Am Coll Cardiol310191025CrossRefPubMed Mathewson, J, Waldman, J, George, L,  et al. 1984shared coronary arteries and coronary venous drainage in thoracopagus twinsJ Am Coll Cardiol310191025CrossRefPubMed
37.
go back to reference Messmer, B, Hornchen, H, Kosters, C 1981Surgical separation of conjoined xiphiopagus twinsSurgery89622625PubMed Messmer, B, Hornchen, H, Kosters, C 1981Surgical separation of conjoined xiphiopagus twinsSurgery89622625PubMed
38.
go back to reference Micheli, JL, Sadeghi, J, Freeman, C, et al. 1978An attempt to separate xiphopagus twins sharing a common heart, liver and duodenumJ Pediatr Surg13139142CrossRefPubMed Micheli, JL, Sadeghi, J, Freeman, C,  et al. 1978An attempt to separate xiphopagus twins sharing a common heart, liver and duodenumJ Pediatr Surg13139142CrossRefPubMed
39.
go back to reference Mudalier, AL 1930Double monsters: a study of their circulatory system and some other anatomical abnormalities, and the complications in labourJ Obstet Gynaecol Br Emp37753768CrossRef Mudalier, AL 1930Double monsters: a study of their circulatory system and some other anatomical abnormalities, and the complications in labourJ Obstet Gynaecol Br Emp37753768CrossRef
40.
go back to reference Nightingale, KW, Ayim, EN, Kyambi, JM, et al. 1981The three cases of conjoined twins of Nairobi, 1976–1979East Afr Med J58960966PubMed Nightingale, KW, Ayim, EN, Kyambi, JM,  et al. 1981The three cases of conjoined twins of Nairobi, 1976–1979East Afr Med J58960966PubMed
41.
go back to reference Norwitz, ER, Hoyte, LP, Jenkins, KJ, et al. 2000Separation of conjoined twins with the twin-to-twin reversed arterial perfusion sequence after prenatal planning with three-dimensional modelingN Engl J Med343399402CrossRefPubMed Norwitz, ER, Hoyte, LP, Jenkins, KJ,  et al. 2000Separation of conjoined twins with the twin-to-twin reversed arterial perfusion sequence after prenatal planning with three-dimensional modelingN Engl J Med343399402CrossRefPubMed
42.
go back to reference Oakenschott, S 1974Four symmetrical thoracopagi: organ-weights in conjoined twinsActa Anat9015CrossRef Oakenschott, S 1974Four symmetrical thoracopagi: organ-weights in conjoined twinsActa Anat9015CrossRef
43.
go back to reference Olcay, I, Yacesen, S, Zorludemir, U 1958Conjoined ischiopagus twinsTurk J Pediatr27241246 Olcay, I, Yacesen, S, Zorludemir, U 1958Conjoined ischiopagus twinsTurk J Pediatr27241246
45.
go back to reference O’Rahilly, R, Muller, F 1998Developmental stages in human embryos. Publ. no. 637Carnegie Institute of WashingtonWashington (DC) 97108 O’Rahilly, R, Muller, F 1998Developmental stages in human embryos. Publ. no. 637Carnegie Institute of WashingtonWashington (DC) 97108
47.
go back to reference Panteleon-Mena, R 1967The conjoined twins of Barrio Ceiba NorteBirth Defects Orig Art Ser3144 Panteleon-Mena, R 1967The conjoined twins of Barrio Ceiba NorteBirth Defects Orig Art Ser3144
48.
go back to reference Patel, R, Fox, K, Dawson, J, et al. 1977Cardiovascular anomalies in thoracopagus twins and the importance of preoperative cardiac evaluationBr Heart J3912541258CrossRefPubMedPubMedCentral Patel, R, Fox, K, Dawson, J,  et al. 1977Cardiovascular anomalies in thoracopagus twins and the importance of preoperative cardiac evaluationBr Heart J3912541258CrossRefPubMedPubMedCentral
49.
go back to reference Patel, B, Ho, J, Sherry, M, Ryan, M 1983Thoracoomphalopagus conjoined twins: preoperative evaluation by scintigraphyAm J Radiol140113114 Patel, B, Ho, J, Sherry, M, Ryan, M 1983Thoracoomphalopagus conjoined twins: preoperative evaluation by scintigraphyAm J Radiol140113114
50.
go back to reference Ramp, JB, Baylor, JR, Casamento, VK, et al. 1989Conjoined twins: a multidisciplinary approachNeonatal Netw82939PubMed Ramp, JB, Baylor, JR, Casamento, VK,  et al. 1989Conjoined twins: a multidisciplinary approachNeonatal Netw82939PubMed
51.
go back to reference Razavi-Encha, F, Mulliez, N, Benhaiem-Sigaux, N, et al. 1987Cardiovascular abnormalities in thoracopagus twins: embryological interpretation and reviewEarly Hum Dev15 3344CrossRefPubMed Razavi-Encha, F, Mulliez, N, Benhaiem-Sigaux, N,  et al. 1987Cardiovascular abnormalities in thoracopagus twins: embryological interpretation and reviewEarly Hum Dev15 3344CrossRefPubMed
52.
go back to reference Riker, W, Traisman, H 1964Conjoined twins: report of three casesIll Med J126450454 Riker, W, Traisman, H 1964Conjoined twins: report of three casesIll Med J126450454
53.
54.
go back to reference Seo, JW, Shin, SS, Chi, JG 1985Cardiovascular system in conjoined twins: an analysis of 14 Korean casesTeratology32151161CrossRefPubMed Seo, JW, Shin, SS, Chi, JG 1985Cardiovascular system in conjoined twins: an analysis of 14 Korean casesTeratology32151161CrossRefPubMed
55.
go back to reference Shaaban, VH, Hussein, M, El-Minawi, MF, et al. 1966Conjoined twinsJ Egypt Med Assoc53442446 Shaaban, VH, Hussein, M, El-Minawi, MF,  et al. 1966Conjoined twinsJ Egypt Med Assoc53442446
56.
go back to reference Shortall CJ (1931) A case of double monster. Ir J Med Sci 278 Shortall CJ (1931) A case of double monster. Ir J Med Sci 278
57.
go back to reference Simpson, JS, Mustard, WT, Moes, CAF, et al. 1970Emergency separation of thoracopagus (twins joined at thorax) in the newborn period: importance of preoperative cardiac evaluationJ Pediatr Surg67697702 Simpson, JS, Mustard, WT, Moes, CAF,  et al. 1970Emergency separation of thoracopagus (twins joined at thorax) in the newborn period: importance of preoperative cardiac evaluationJ Pediatr Surg67697702
58.
go back to reference Soonawalla, RP, Patel, DN 1960A brief review of double monsters with description of two cases of thoracopagusJ Obstet Gynaecol India11201206 Soonawalla, RP, Patel, DN 1960A brief review of double monsters with description of two cases of thoracopagusJ Obstet Gynaecol India11201206
59.
go back to reference Spencer, R 1956Surgical separation of Siamese twins: case reportSurgery39827833PubMed Spencer, R 1956Surgical separation of Siamese twins: case reportSurgery39827833PubMed
61.
go back to reference Spencer, R 2000Theoretical and analytical embryology of conjoined twins: part I: embryogenesisClinical Anatomy133653CrossRefPubMed Spencer, R 2000Theoretical and analytical embryology of conjoined twins: part I: embryogenesisClinical Anatomy133653CrossRefPubMed
62.
go back to reference Spencer, R 2001Theoretical and analytical embryology of conjoined twins: part II: embryogenesisClinical Anatomy1397120CrossRef Spencer, R 2001Theoretical and analytical embryology of conjoined twins: part II: embryogenesisClinical Anatomy1397120CrossRef
63.
go back to reference Spencer, R, Robichaux, WH 1998Prosopo-thoracopagus conjoined twins and other cephalopagus-thoracopagus intermediates: case report and review of the literaturePediatr Devel Pathol1164171CrossRef Spencer, R, Robichaux, WH 1998Prosopo-thoracopagus conjoined twins and other cephalopagus-thoracopagus intermediates: case report and review of the literaturePediatr Devel Pathol1164171CrossRef
64.
go back to reference Spencer, R, Robichaux, WH, Seo, JW 1997Abnormal vasculature of the liver in thoracopagus twins: case reportPediatr Pathol Lab Med17315327CrossRefPubMed Spencer, R, Robichaux, WH, Seo, JW 1997Abnormal vasculature of the liver in thoracopagus twins: case reportPediatr Pathol Lab Med17315327CrossRefPubMed
65.
go back to reference Spitz, L, Stringer, M, Kiely, EM, et al. 1994Separation of brachio-thoraco-omphalo-ischiopagus bipus conjoined twinsJ Pediatr Surg29477481CrossRefPubMed Spitz, L, Stringer, M, Kiely, EM,  et al. 1994Separation of brachio-thoraco-omphalo-ischiopagus bipus conjoined twinsJ Pediatr Surg29477481CrossRefPubMed
66.
go back to reference Sturrock, MM, McKenzie, J 1973The abnormalities and genesis of cephalo-thoracopagus (janiceps) twins: report of a caseAnat Anz133350362PubMed Sturrock, MM, McKenzie, J 1973The abnormalities and genesis of cephalo-thoracopagus (janiceps) twins: report of a caseAnat Anz133350362PubMed
67.
go back to reference Synhorst, D, Matlak, M, Roan, Y, et al. 1979Separation of conjoined thoracopagus twins joined at the right atriaAm J Cardiol43662665CrossRefPubMed Synhorst, D, Matlak, M, Roan, Y,  et al. 1979Separation of conjoined thoracopagus twins joined at the right atriaAm J Cardiol43662665CrossRefPubMed
68.
go back to reference Tan, KL, Goon, SM, Salmon, Y, Wee, JH 1971Conjoined twinsActa Obstet Gynecol Scand50373380CrossRefPubMed Tan, KL, Goon, SM, Salmon, Y, Wee, JH 1971Conjoined twinsActa Obstet Gynecol Scand50373380CrossRefPubMed
69.
go back to reference Allen, MI, Smith, DW, Shepard, TH 1983Twin reversed arterial perfusion sequence: a study of 14 twin pregnancies with acardiusSemin Perinatol4285293 Allen, MI, Smith, DW, Shepard, TH 1983Twin reversed arterial perfusion sequence: a study of 14 twin pregnancies with acardiusSemin Perinatol4285293
71.
go back to reference Aorn, J, Lederhandler, M, Roessmann, U 1984Central nervous system of a thoracopagusActa Neuropathol (Berl)638082CrossRef Aorn, J, Lederhandler, M, Roessmann, U 1984Central nervous system of a thoracopagusActa Neuropathol (Berl)638082CrossRef
Metadata
Title
Congenital Heart Defects in Conjoined Twins: Outcome After Surgical Separation of Thoracopagus
Authors
C. J. McMahon
R. Spencer
Publication date
01-02-2006
Publisher
Springer New York
Published in
Pediatric Cardiology / Issue 1/2006
Print ISSN: 0172-0643
Electronic ISSN: 1432-1971
DOI
https://doi.org/10.1007/s00246-005-0835-5

Other articles of this Issue 1/2006

Pediatric Cardiology 1/2006 Go to the issue