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DIGITAL INITIATIVES: 3D PRINTING :
CONJOINED TWINS :
MEDICAL: PROCEDURES :
DECISION MAKING :
UNIVERSITY OF FLORIDA HEALTH (UF HEALTH):
Florida Doctors Separate Conjoined Twins
Connected at Heart With Help of 3-D Printing
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Florida Doctors Separate Conjoined Twins
Connected at Heart With Help of 3-D Printing
By AVIANNE TAN
September 2, 2016, 2:43 PM ET
ABC News
http://abcnews.go.com/Health/
florida-doctors-separate-conjoined-twins-connected-heart-printing/
story?id=41823333
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A shorter URL for the above link:
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http://tinyurl.com/hx2jpln
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Doctors at a hospital in Gainesville, Florida, recently separated
conjoined twin girls with the help of 3-D printing, University of Florida
Health (UF Health) announced this week.
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Though the procedure happened in June, hospital officials and the twins'
parents only decided to make an announcement this Wednesday, according to
UF Health media relations coordinator Rossana Passaniti.
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She told ABC News today they wanted to make sure the twins were well into
their recovery before sharing news of the successful separation. The
parents, Mark and Jacquelyn (who wished not to be identified by their last
names), decided "now was a good time" since they were preparing to finally
get to take their girls home.
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The twins, Scarlett and Savannah, were born at UF Health Shands Children's
Hospital in April, according to a news release from UF Health. The babies
"each had their own complete set of organs but were attached at the liver,
diaphragm, sternum and heart."
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"It was a really complex connection because it was close to very important
veins in the hearts of both babies," said Dr. Mark Bleiweis in the news
release.
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Bleiweis is chief of pediatric and congenital cardiovascular surgery at UF
Health and the one who performed the heart separation for the twins.
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There "have not been many successful separations with a cardiac
connection," Bleiweis explained. "It became a very challenging planning
process for us."
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To help the doctors prepare for the risky procedure, they created what
they believe is the "first-ever 3-D printed conjoined twin heart," UF
Health said.
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The life-sized model allowed surgeons to examine the twins' shared
structures in the heart and practice the surgical separation itself, the
health system explained.
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The actual procedure took about six to eight hours, according to UF
Health. To differentiate between the various tubes and electrical wires
keeping the twins alive, surgeons wrapped them in orange tape for one girl
and blue tape for the other.
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After the separation, the sisters still had to undergo over a dozen more
surgeries each to repair where they had once been connected, UF Health
said.
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But now, three months after they were first separated, Scarett and
Savannah getting ready to go home.
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The complete articles may be read at the URLs provided for each.
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Twins born joined at the heart survive separation at UF Health Shands
By Deborah Strange
The Gainesville Sun
Gainesville.com
http://www.gainesville.com/news/20160831/
twins-born-joined-at-heart-survive-separation-at-uf-health-shands
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A shorter URL for the above link:
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http://tinyurl.com/h92q9jp
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The first 20 weeks of Jacquelyns pregnancy seemed normal, until a scan
gave an ultrasound technician pause.
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Jacquelyn, who thought she was carrying one baby, was carrying two. The
twins were conjoined at the heart, liver, sternum and diaphragm.
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Three doctors told Jacquelyn and her partner, Mark, that the babies
couldnt survive.
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Thirty-five weeks and five days into her pregnancy, Jacquelyn delivered
the girls via cesarean section April 12 at UF Health Shands Hospital.
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In June, the twins were separated.
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snip
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Jacquelyn and Mark, who are keeping their family name private, were
referred to UF Health and its Congenital Heart Center. Dr. Jennifer Co-Vu,
director of UFs Fetal Cardiac Program, saw Jacquelyn at 22 weeks and
thought there was a chance for the babies to survive, conjoined or
separated.
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It really took us a while to grasp that, Jacquelyn said. We had been told
no for so long. Jubilation followed the shock, Mark said.
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A team of doctors in surgery, cardiology, obstetrics and gynecology,
neonatology, radiology, anesthesiology, plastic surgery and respiratory
therapy were involved in planning the babies delivery, separation and pre-
and post-operative care.
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It took a village, literally, to separate these twins, said Dr. Saleem
Islam, chief of UF Healths pediatric surgery division.
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Scarlett and Savannah weighed a combined 10 pounds and 8 ounces when they
were born. Jacquelyn was awake and anxious during her C-section, she said.
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Each girl had her own complete set of organs. Scarlett and Savannah were
born facing each other, and they stayed like that in the hospital until
their separation in June.
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Planning the surgery took hundreds of hours, Co-Vu said. Using an MRI and
CT scan of the babies hearts, the team strategized the separation with a
lifesize 3-D model likely the first of its kind, according to UF Health.
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Conjoined twins connected at the heart and liver
successfully separated at UF Health
August 31, 2016
ROSSANA PASSANITI
http://news.ufl.edu/articles/2016/08/conjoined-twins-connected-
at-the-heart-and-liver-successfully-separated-at-uf-health.php
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A shorter URL for the above link:
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http://tinyurl.com/gojnw4l
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Conjoined twin girls who were connected at the heart and other organs have
been successfully separated in an extremely rare surgery performed by
physicians at University Florida Health Shands Childrens Hospital.
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The girls, who were born at UF Health Shands Hospital in April and
separated in June, each had their own complete set of organs but were
attached at the liver, diaphragm, sternum and heart, called a
thoraco-omphalopagus connection. Their hearts were the most critical
element of the separation, according to Dr. Mark Bleiweis, M.D., chief of
pediatric and congenital cardiovascular surgery at UF Health and the
surgeon who performed the heart separation. The twins shared a connection
at the upper chamber of the heart, called the atrium, where blood enters
the heart.
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It was a really complex connection because it was close to very important
veins in the hearts of both babies, Bleiweis said. In the world, there
have not been many successful separations with a cardiac connection. It
became a very challenging planning process for us, and, ultimately, a
challenging separation.
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Dr. Jennifer Co-Vu, M.D., FAAP, specializes in fetal cardiac care. She
first studied the physiology of the unborn twins during an hourslong
ultrasound in Jacquelyns 21st week of pregnancy and she told the parents
she thought that not only would the babies survive birth, they also would
survive after they were born. The parents had two options: to attempt
separation, or to be prepared to raise conjoined twins, Co-Vu said.
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snip
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When I saw the heart structures and liver structures in utero, I had a
feeling that we could separate them, but I had to examine the anatomy more
closely and consult with my cardiology colleagues at the UF Health
Congenital Heart Center, said Co-Vu, director of the Fetal Cardiac
Program. I was able to give them hope, yet at the same time, I told them I
was cautiously optimistic. We are very fortunate that this was a success.
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Conjoined twins occur only in about 1 in 200,000 live births. Between 40
and 60 percent of conjoined twins are stillborn, and 35 percent who live
through birth survive only one day, according to the University of
Maryland Medical Center. Only about 5 to 25 percent of conjoined twins
survive, and survival of twins connected at the heart is extremely rare.
In cases where the hearts are joined, the decision is often made to not do
separation surgery in cases where there is a connection at the heart.
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In addition to being joined at the heart, the girls also shared a large,
fused liver, according to Saleem Islam, M.D., M.P.H., chief of the
division of pediatric surgery in the UF College of Medicine.
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The liver, from all of the imaging we obtained both before the babies
birth and after they were born, indicated that it was almost like one
giant liver without any true plane of separation, Islam said.
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Without a clear picture of how to separate the liver before the surgery
took place, Islam and his team had to use a method called intraoperative
ultrasound to guide the separation. Using this method, Islam looked for
areas of the joined liver that were free from large blood vessels.
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Conjoined twins defy death with surgery that separates their hearts
By AMERICAN HEART ASSOCIATION NEWS
http://news.heart.org/conjoined-twins-defy-death-
with-surgery-that-separates-their-hearts/
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A shorter URL for the above link:
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http://tinyurl.com/zeacwg5
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Dr. Jennifer Co-Vu, the girls cardiologist at University of Florida
Health, said she saw the parents when they had already been told by at
least two high-risk obstetricians that based on the studies and
literature, mortality is extremely high if not almost 100 percent, as
quoted by one paper if there is connection in the heart.
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But she saw a glimmer of hope.
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The way they were connected in the upper chambers, one in the right atrium
connected to the other in the left atrium, from what I saw from that
moment on, we could separate babies, said Co-Vu, clinical assistant
professor in the department of pediatrics and director of the hospitals
Fetal Cardiac Program. There was a possibility of surgery.
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The risks were still high. One or both babies could die.
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Doctors told Clark two days before Christmas that her babies might live
only a few hours. A month after hearing that grim news, she wrote in an
online journal she kept of her experience about the glimmer of hope she
received from Co-Vu.
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The doctor started drawing pictures and explaining anatomy of the hearts.
She said our girls have two fully formed hearts. They are just attached,
she wrote. She went through the whole list of pieces and parts, and they
have them all. The right size, and where they are supposed to be.
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She said, they are the most complete and balanced conjoined twins not only
has she ever seen, but had been able to research.
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From there, it was all about waiting. And hope.
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The girls were born the morning of April 12.
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They came out holding onto each other, like in a hug, Clark wrote in her
journal. And it was beyond precious.
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They were connected at the liver, diaphragm, sternum and the upper chamber
of the heart, known as a thoraco-omphalopagus connection. At 2 months old,
doctors operated.
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One of the technologies that helped Scarlett and Savannah was considered
experimental just a few years ago.
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At the American Heart Associations Scientific Sessions 2014 conference,
Dr. Matthew Bramlet presented research about some of the first cases where
3-dimensional printed models of the heart were used to help surgeons treat
heart birth defects.
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Typically, doctors use 2D images taken by X-ray, ultrasound and MRI for
surgical planning. But now, with these images as a guide, doctors can use
high-tech printers to build detailed 3D models from materials such as
plaster or ceramic to help give more detail and reveal even the most
complicated structural abnormalities.
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In two years, the use of 3-D printing in medicine is growing
exponentially, moving from experimental use to breaking new ground. The
models are used in surgery pre-planning, determining the best treatment,
and how and where to operate.
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