printable versionTwins prepare for separation surgery at Packard Children's
BY KRISTA CONGER
Yurelia and Fiorella Rocha-Arias were born joined together, sharing the right upper chambers of their hearts and a single liver. Doctors at Packard Children’s Hospital have evaluated them for separation surgery.
Twin girls from Costa Rica who were born joined at the chest and belly will be separated surgically at Lucile Packard Children's Hospital this fall, said hospital physicians.
The 2-year-old girls, Yurelia and Fiorella Rocha-Arias, are joined facing each other at the chest and the abdomen, the physicians said at a Sept. 20 news conference. The right upper chambers of their hearts are connected and they share a single liver.
"Like all cases of conjoined twins, this surgery is complex and risky," said Gary Hartman, MD, who leads a team of surgeons planning for the separation. The procedure is complicated by the fact that Yurelia also has a congenital heart condition that will likely require repair shortly after the separation surgery. Fiorella has a less serious heart problem that may not require surgery.
Although the estimated survival rate for this type of separation surgery, for both twins, is approximately 50 percent, Hartman and his colleagues determined that the separation is possible after an exhaustive series of diagnostic tests in July and August. Without separation, the girls cannot turn away from one another or walk independently.
Although this will be the first such surgery performed at Packard Children's, Stanford Hospital & Clinics separated two sets of twins before the pediatric hospital was formed in 1991. In addition, several members of the girls' surgical team have had experience with similar surgeries. Hartman has participated in four previous separations of conjoined twins, including the widely publicized, successful separation of conjoined twins at Children's National Medical Center in Washington, DC, in June of 2004. Peter Lorenz, MD, chief of plastic surgery at Packard Children's, and cardiothoracic surgeon Frank Hanley, MD, have also been involved in separations of conjoined twins.
Yurelia and Fiorella arrived in Palo Alto from the Costa Rican city of San Jose on July 25 with their mother, Maria Elizabeth Arias. Their transportation and lodging were arranged by Mending Kids International, an organization dedicated to providing complex surgical care to children outside the United States.
The girls are the youngest of 11 siblings. Like any sisters, they sometimes fight, scratching or hitting each other. They also share toys and enjoy watching children's videos. Fiorella eats more and is slightly larger than Yurelia. The girls get along well with their siblings, but they have distinct personalities.
"Fiorella is very shy," said Arias. "Yurelia is more sociable."
The twins are already well-known in the hospital. In the past eight weeks they've experienced CT scans, MRIs and cardiac catheterization. On Aug. 21, physicians implanted three skin expanders—rectangular, balloon-like devices that will be gradually filled with a saline solution to encourage the growth of the excess skin that will be used to cover the surgical site after separation. The exact timing of the surgery—currently estimated to occur in mid-November—will depend on the success of the skin expansion, which seems to be progressing well. In the meantime, the physicians will continue to watch the twins carefully.
"We really want to get to know the girls as patients," said pediatric cardiac anesthesiologist Gail Boltz, MD. "We want them to recognize and be comfortable with us."
The twins, who share a blood supply, present a unique challenge to Boltz and her team of anesthesiologists. Although anesthesia administered to one of the girls affects both, each child will be individually anesthetized from the beginning of the surgery to prepare for the separation and to enable the anesthesiologists to quickly and accurately meet the needs of each child as their connection is gradually separated.
Each girl will have her own team of surgeons and anesthesiologists. They will be moved to separate operating rooms after the separation to complete surgery.
Surgeons and physicians at Packard Children's are donating their time and expertise to treat Yurelia and Fiorella. Additionally, the hospital is providing medical and clinical care at no cost to Yurelia and Fiorella's family. Gifts in support of Packard Children's Hospital and the expert care it gives to children, like Yurelia and Fiorella, who are undergoing complex surgery can be made by visiting http://twins.lpch.org and clicking the "How to Help" link. The Web site also contains more information about Yurelia and Fiorella, along with regular updates about their condition.