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3-year-old conjoined girls from Romania stay together. Family's plans for future unknown
By Tracy Wheeler
Beacon Journal medical writer
Published on Tuesday, Aug 14, 2007
CLEVELAND: Tatiana, the smaller of the conjoined Dogaru twins, has high blood pressure, eats very little, and needed therapy to learn to walk.
Her conjoined sister, Anastasia, has no functioning kidney, low blood pressure and a heart vessel defect.
And the girls, connected at their heads, share a circulatory system, bone and brain tissue.
From the time Claudia and Alin Dogaru brought their girls to Cleveland in April, doctors knew that separating the 3-year-old Romanian twins would be a complex procedure.
In the past two months, though, they've learned that the separation surgery carried even more complications than they initially imagined brain swelling, unforeseen heart problems, and Anastasia's dangerously low blood pressure when sedated.
Monday, Rainbow Babies & Children's Hospital announced that the surgical separation was called off.
''Based on information gained from the most recent series of tests, it has become clear that the risk of further surgery outweighs the likelihood of benefit,'' Dr. Nathan Levitan, chief medical officer of University Hospitals Case Medical Center, said at a news conference Monday.
In a video produced by the hospital, Alin Dogaru said he and his wife had talked to doctors ''about stopping if they feel it's not going to be OK.'' He then thanked the doctors for ''stopping at the right time.''
''We trust them,'' Claudia Dogaru added. ''Together, we think we made the best decision for the girls.''
In April and May, doctors used wire coils fed through catheters to separate the girls' shared circulatory systems. The procedure was considered a success, as each girl was able to circulate blood within their own bodies without relying on her sister.
In June, though, the difficulties became more apparent. When doctors opened the girls skull, they found brain swelling, while Anastasia's blood pressure dropped dangerously low.
The dura the membrane covering the brain was so ''abnormally tight'' that ''it wasn't safe to cut into it,'' Levitan said.
Over the next several weeks, doctors ran tests to understand what was leading to Anastasia's low blood pressure and what was causing the tightened dura, along with additional heart studies.
Test results from last week show that both girls' hearts are overworking Tatiana's as if fighting a blockage; Anastasia's as a result of her low blood pressure.
These findings left doctors with two questions: Would the twins benefit from more surgery? Is separation technically feasible?
The answer to both questions was no.
Even if doctors could handle Anastasia's blood pressure and even if they could safely cut through the dura, Levitan said, they would still have to cut large blood vessels at the back of their brains and alter the blood flow in each girl, which would raise a substantial risk of bleeding, stroke and loss of blood pressure control.
''The decision not to move forward with surgical separation was a very difficult one,'' Levitan said, ''but it was made with the safety of the twins in mind, and it was guided by the age-old medical oath, 'first, do no harm.'''
The decision, he said, leaves many unanswered questions, such as: Will the family remain in the United States, or return to Romania? Who will provide ongoing medical care and who will pay for it?
''We will do all that we can to support the family as they make plans for the future,'' Levitan said. However, he said it is unlikely that any other hospital would be able to better handle the complicated procedure.
''I'm not aware of any resources available elsewhere that aren't available here,'' he said.
The medical literature shows just 14 cases like the Dogaru twins' in the last 50 years. Of those, only 10 percent lived to the age of 11.
For now, though, the girls are doing well, Levitan said.
''At the present time, Anastasia and Tatiana are thriving,'' he said. ''They're active. They're happy. They're playing. They're on no medication at all.''
Tracy Wheeler can be reached at 330-996-3721 or tawheeler@thebeaconjournal.com.
CLEVELAND: Tatiana, the smaller of the conjoined Dogaru twins, has high blood pressure, eats very little, and needed therapy to learn to walk.
Get the full article here.
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