The Outcomes of Surgical Separation in Thoracopagus Twins with Conjoined Hearts: An Analysis of the Literature

We sought to perform a comprehensive review of reported cases of conjoined thoracopagus twins with cardiovascular conjunction to determine the overall survival after separation and factors that might be associated with survival. We performed a systematic review of cases of thoracopagus twins with conjoined cardiovascular systems reported in the English medical literature using Embase, PubMed, Web of Science, and Scopus. We employed standard statistical methods to analyze differences among groups. We identified 102 unique cases of thoracopagus twins (69% female) with some degree of cardiovascular conjunction who had undergone surgical separation. We identified 6 distinct types of cardiovascular union. Median age was 47 days (IQR 12, 120). Survival to at least hospital discharge occurred in 51% (105/204). Median age at separation was lower in emergent (9 days, IQR 1, 25) versus elective cases (93 days, IQR 49, 180) (p < 0.0001). Survival to hospital discharge was higher in those who underwent elective separation (70%, 93/132 total children versus 17%, 12/72) (p < 0.0001). Survival was associated with the type of cardiovascular union (p < 0.0001). The separation of thoracopagus twins with cardiovascular conjunction is higher than expected. Increased survival is associated with elective separation, older age, and shared pericardium only. These findings suggest survival could be improved with better delineation of degree of union and delayed separation.

Early ultrasound diagnosis of conjoined twins at eight weeks of pregnancy: A case report

BACKGROUND

Conjoined twins are a rare occurrence, and the majority of these malformations are detected during second trimester screening.

CASE SUMMARY

Herein we report a case of conjoined twins, which was diagnosed by ultrasound at 8 wk gestation and was normal at 7 wk gestation. The two fetuses shared one heart and were diagnosed as thoracopagus twins. This is the first report of conjoined twins diagnosed at 8 wk gestation. The pregnancy was terminated electively at 9 wk gestation. Because some congenital malformations can be diagnosed earlier, a prenatal ultrasound examination at an early gestational stage cannot be dismissed.

CONCLUSION

This case demonstrates that a 7-8 wk gestation might be the earliest period when conjoined twins can be diagnosed by ultrasound.

The surgical principles of conjoined twin separation

The surgical management of conjoined twin separation is a complex, multidisciplinary process that requires extensive pre operative planning and organization for optimal outcomes. Identification of detailed anatomic relationships is necessary prior to the separation. The use of 3D modeling is extremely helpful for conceptualization of the operation. The principles of the separation are dependent on the type of twin, although each variant of symmetric twins has certain commonalities related to their embryology that can be considered when planning the operation. The use of tissue expansion in the pre operative planning stage is highly recommended due to known issues with closure after separation. In order to ensure a safe, successful operation, we recommend organized pre operative planning meetings with at least one simulation of the separation event with multidisciplinary involvement.

A detailed systematic anatomical study of monocephalic conjoined symmetric twin lambs

A case of conjoined twins with monocephalus, thoracopagus, partial abdominopagus, tetrabrachius and tetrascelus in lambs complicated with several defects of skeletal, cardiovascular, gastrointestinal, and urogenital systems is reported. The twins were dead and delivered by cesarean section. This case report highlights the detailed anatomical study of defects in different systems due to an abnormal birth defect.

Conjoined twins: a rare case of thoraco-omphalopagus

Conjoined twins are a rare entity. Only few cases have been reported in the medical literature. They are a rare and exclusive type of monozygotic twins. They are caused by a faulty division of the embryonic disk. Due to high post-natal morbidity and mortality, an early pre-natal diagnosis is a must. All the monozygotic twins should be carefully screened for conjoinnment and if it is present, the type and the degree of sharing of the foetal organs should be delineated. There are many associated anomalies, of which congenital heart defects are the major prognostic factors. Here, we are reporting a case of thoraco-omphalopagus in which there was sharing of the foetal heart, liver and the intestinal loops.