Issue |
J Extra Corpor Technol
Volume 20, 1988
Proceedings of AmSECT’s 26th International Conference
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Page(s) | 114 - 118 | |
DOI | https://doi.org/10.1051/ject/198820S114 | |
Published online | 25 August 2023 |
Original Article
Separation of Conjoined Twins Utilizing Cardiopulmonary Bypass
The Johns Hopkins Medical Institutions, Baltimore, MD
* Direct communications to: Candace Banchieri, Department of Cardiac Surgery, Blalock 618, Johns Hopkins Hospital, Baltimore, MD 21205.
The incidence of conjoined twins occurs once in every two million live births. Successful separation has occurred in 50% of these patients. Previous attempts to separate twins at the sagittal sinus have resulted in death. On September 5, 1987, the team at Johns Hopkins Hospital was the first to successfully separate conjoined twins at the sagittal sinus. One key to this success was the use of cardiopulmonary bypass, deep hypothermia and circulatory arrest.
Each patient was cannulated with a 14 Fr. aortic cannula and a 22 Fr. venous cannula in the right atrium. They were then connected to completely separate cardiopulmonary bypass circuits. Cardiopulmonary bypass was initiated utilizing a roller pump, pediatric membrane oxygenator with integral cardiotomy, and an arterial filter. The twins were cooled to 20 degrees centigrade in preparation for circulatory arrest. During circulatory arrest, separation occurred and repair was accomplished utilizing direct suture and pericardial patches. When repair was complete, cardiopulmonary bypass was resumed and rewarming begun. At a rectal temperature of 33 degrees centigrade, cardiopulmonary bypass was discontinued.
The two major benefits of extra-corporeal circulation in this procedure were maintaining hemodynamic stability and the ability to regulate metabolic demands. The use of cardiopulmonary bypass was a solution to the obstacles presented. The ability to control blood flow, temperature and volume resulted in a successful separation of these patients.
© 1988 AMSECT
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