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Tuesday, 30 April, 2002, 10:21 GMT 11:21 UK
Heart-share twins: The risks
The operation always carried huge risks
Doctors were not sure whether either of the Siamese twins born in London on Monday could survive independently.

Experts said that any attempt to operate on Natasha and Courtney came with immense risks, and certainly no guarantee of success.

They were not even prepared to contemplate surgery while the twins were in a weakened condition.

And as both tried to thrive on a single heart, significant improvement was always less likely.

Every case in which twins are joined is unique - they differ in which organs they share, and the extent to which they share them.

Shared heart risks

No twin who fully shares a heart has ever survived long-term from separation surgery.

The Manchester twins - Rosie and Gracie Attard, did not share a heart - but had only interlocking circulation, which was easier to divide.

However, when a heart is shared, there can only be one outcome for one of the twins, who must be sacrificed to save the life of the other.

Both will certainly die if separation is not attempted.

The heart of a newborn baby is about the same size as a plum - perhaps a little larger in the case of Natasha and Courtney.

And in this case, the blood vessels which supply the new twins were intertwined, making any operation immensely difficult.

Scanning techniques

Professor Lewis Spitz, who led the Great Ormond Street Hospital team treating the twins, said that the way their heart was structured would make it nigh-on impossible to construct a viable, new heart just for one of them.

Surgeons usually try, through a patchwork of scans and tests, to work out the exact configuration of the walls, valves and vessels which form the shared heart.

Modern scanning techniques such as MRI and ultrasound allow a three-dimensional picture to be built up of the interlocking network of muscle and tissues which make up the organ.

Then the large team of experts will devise a strategy to separate the weaker twin's side of the blood flow from the organ, and reconstruct it so it works only for the stronger of the two.

Success is dependent on minimising the number of "surprises" that surgeons uncover when they painstakingly perform the operation.

Rethinking your strategy "on the hoof" adds to the risks to the patient - but this is not always avoidable.

Doubts over heart

Professor Heinz Rode, from the Red Cross War Memorial Hospital in Cape Town, South Africa, has been part of teams which have operated on more than a dozen shared-heart conjoined twins.

He told the BBC: "The operation is extremely risky, but it depends on the pre-operative assessment, which is very difficult.

"Very often, at the time of the operation, one comes across unexpected anatomy that one has to deal with."

The heart had been formed with contributions from both babies - but the greatest proportion came from Natasha.

See also:

07 Dec 00 | Health
Siamese twin op details revealed
25 Aug 00 | Q-S
Siamese twins
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