stanford medicine


main image

Independence day

Formerly joined twins survive and thrive

Like many twin sisters, Yurelia and Fiorella Rocha-Arias shared a bond from birth.

But unlike most, theirs was made of flesh and blood. The spirited 2-year-olds were born facing each other, joined at the chest and abdomen. They shared a liver, and their hearts were fused. The physical connection is now gone — the result of a stunningly complex feat at Lucile Packard Children’s Hospital.

“My girls were born anew in this hospital,” said their mother, Maria Elizabeth Arias at a January press conference. “My dreams have come true.” The family returned home to their native Costa Rica, and the twins’ father and nine siblings a few days later. Lead surgeon Gary Hartman, MD, is also thrilled at the successful outcome of the case.

“When I first met the family I couldn’t stop thinking, ‘I’m taking these girls away, and I may not bring them back,’” says Hartman. He had estimated the chances of both girls surviving the procedure to be about 50 percent.

The family’s departure marked the end of nearly a year of planning. The nonprofit organization Mending Kids International was looking for a hospital with the expertise to separate the girls. Yurelia also had a congenital cardiac condition known as double-outlet right ventricle that would require correction soon after separation. Packard Children’s fit the bill.

The girls were separated on Nov. 12, 2007, in a nine-hour procedure. Each girl had her own complete team of medical specialists, caregivers and equipment, and traffic flow in the operating room was carefully choreographed to allow the surgical specialists to work in turns. The operation proceeded without a hitch.

“The most exciting moment,” anesthesiologist Gail Boltz, MD, recalls, “was in the final stage of the separation, when surgeons placed a clamp on the connection between the girls’ hearts.” This was the riskiest part of the procedure because it was simply unknown how much the girls needed each other to survive. “Immediately — as if someone had turned on a switch — their individual stats improved,” says Boltz. “Their blood pressures improved. It was clear the girls were going to be stronger apart.”

Asked whether the girls will remember being conjoined or their time at Packard Children’s, child psychiatrist Richard Shaw, MD, replies “Probably not consciously, but there may be physical memories. Certain types of pressure on their bodies or positions may evoke feelings of familiarity, much like certain smells can trigger emotions in people years after an event.”

The girls now act and look pretty much like normal toddlers. They’ve received regular physical and occupational therapy to help them learn to move and walk apart, and feeding therapy helped Fiorella, who had been living primarily off her sister’s food intake, learn to eat. There have been psychological adjustments as well.

“They were always looking for each other in the beginning,” says Arias, noting that the girls sleep together and try to be together as much as possible. She adds, “Yurelia wants her sister to come right when she says so, or else there will be trouble.”

But some things haven’t changed. “Before they were separated, when one girl had something the other wanted, they would fight,” says Arias. “Now that they are’s the same.”






©2008 Stanford University  |  Terms of Use  |  About Us