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Assessment of the Cardiovascular System in Conjoined Thoracopagus Twins

Assessment of the Cardiovascular System in Conjoined Thoracopagus Twins Abstract • The thoracoomphalopagus conjoined twins comprise 75% of all conjoined twins. In the assessment of the organ systems of the twins, the cardiovascular system is important since union of this system in the twins has occurred in 75% of the cases. Of the five cases reported here, two had separate hearts and vessels with a common pericardium only. Two twins were joined at the right atrial level. The fifth pair were connected at both atrial and ventricular levels. It has been suggested that the presence of two separate QRS complexes in the ECG indicates complete separation of the two hearts. Case 4 shows that even in the presence of atrial union, the existence of an atrioventricular block in one twin may produce a very slow heart rate, while the other twin may have a normal rate that will not influence the ventricular rate of the other. In our experience, angiocardiography has been the most useful diagnostic procedure. (Am J Dis Child 132:19-24, 1978) References 1. Simpson JS: Separation of conjoined thoracopagus twins, with the report of an additional case . Can J Surg 12:89-96, 1969. 2. Nichols BL, Blattner RJ, Rudolph AJ: General clinical management of thoracopagus twins . Birth Defects 3:38-51, 1967. 3. Simpson JS, Pelton DA, Swyer PR: The importance of monitoring during operations on conjoined twins . Can Med Assoc J 96:1463-1467, 1967. 4. Mudaliar AL: Double monsters—a study of their circulatory system and some other anatomical abnormalities—and the complications in labour . J Obstet Gynecol Br Emp 37:753-768, 1930.Crossref 5. Kranendonk GH: A thoracopagus with unusual cardiovascular anomalies . Acta Morphol Neerl Scand 5:253-254, 1963. 6. Leachman RD, Latson JR, Kohler CM, et al: Cardiovascular evaluation of conjoined twins . Birth Defects 3:52-65, 1967. 7. Simpson JS, Mustard WT, Moes CAF, et al: Emergency separation of thoracopagus (twins conjoined at thorax) in the newborn period: Importance of careful preoperative cardiac evaluation . Surgery 67:697-702, 1970. 8. Nyun P, Saing H: Thoracoomphalopagus conjoined twins of Burma . J Pediatr Surg 7:691-695, 1972.Crossref 9. Mulcare RJ, Bhokakil P, Potitung P, et al: The surgical separation of the thoracopagus conjoined twins of Korat, Thailand . Ann Surg 172:91-97, 1970. 10. De Angelis RR, Dursi JF, Ibach JR: Successful separation of xiphopagus conjoined twins . Ann Surg 172:302-305, 1970.Crossref 11. Gans SL, Morgenstein L, Gettelman E, et al: Separation of conjoined twins in the newborn period . J Pediatr Surg 3:565-574, 1968.Crossref 12. Rossi P, Bordiuk JM, Golinko RJ: Angiographic evaluation of conjoined twins . Ann Radiol 14:341-349, 1971. http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Diseases of Children American Medical Association

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Publisher
American Medical Association
Copyright
Copyright © 1978 American Medical Association. All Rights Reserved.
ISSN
0002-922X
DOI
10.1001/archpedi.1978.02120260021002
Publisher site
See Article on Publisher Site

Abstract

Abstract • The thoracoomphalopagus conjoined twins comprise 75% of all conjoined twins. In the assessment of the organ systems of the twins, the cardiovascular system is important since union of this system in the twins has occurred in 75% of the cases. Of the five cases reported here, two had separate hearts and vessels with a common pericardium only. Two twins were joined at the right atrial level. The fifth pair were connected at both atrial and ventricular levels. It has been suggested that the presence of two separate QRS complexes in the ECG indicates complete separation of the two hearts. Case 4 shows that even in the presence of atrial union, the existence of an atrioventricular block in one twin may produce a very slow heart rate, while the other twin may have a normal rate that will not influence the ventricular rate of the other. In our experience, angiocardiography has been the most useful diagnostic procedure. (Am J Dis Child 132:19-24, 1978) References 1. Simpson JS: Separation of conjoined thoracopagus twins, with the report of an additional case . Can J Surg 12:89-96, 1969. 2. Nichols BL, Blattner RJ, Rudolph AJ: General clinical management of thoracopagus twins . Birth Defects 3:38-51, 1967. 3. Simpson JS, Pelton DA, Swyer PR: The importance of monitoring during operations on conjoined twins . Can Med Assoc J 96:1463-1467, 1967. 4. Mudaliar AL: Double monsters—a study of their circulatory system and some other anatomical abnormalities—and the complications in labour . J Obstet Gynecol Br Emp 37:753-768, 1930.Crossref 5. Kranendonk GH: A thoracopagus with unusual cardiovascular anomalies . Acta Morphol Neerl Scand 5:253-254, 1963. 6. Leachman RD, Latson JR, Kohler CM, et al: Cardiovascular evaluation of conjoined twins . Birth Defects 3:52-65, 1967. 7. Simpson JS, Mustard WT, Moes CAF, et al: Emergency separation of thoracopagus (twins conjoined at thorax) in the newborn period: Importance of careful preoperative cardiac evaluation . Surgery 67:697-702, 1970. 8. Nyun P, Saing H: Thoracoomphalopagus conjoined twins of Burma . J Pediatr Surg 7:691-695, 1972.Crossref 9. Mulcare RJ, Bhokakil P, Potitung P, et al: The surgical separation of the thoracopagus conjoined twins of Korat, Thailand . Ann Surg 172:91-97, 1970. 10. De Angelis RR, Dursi JF, Ibach JR: Successful separation of xiphopagus conjoined twins . Ann Surg 172:302-305, 1970.Crossref 11. Gans SL, Morgenstein L, Gettelman E, et al: Separation of conjoined twins in the newborn period . J Pediatr Surg 3:565-574, 1968.Crossref 12. Rossi P, Bordiuk JM, Golinko RJ: Angiographic evaluation of conjoined twins . Ann Radiol 14:341-349, 1971.

Journal

American Journal of Diseases of ChildrenAmerican Medical Association

Published: Jan 1, 1978

References