September 22, 2014

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Doctors call off separation surgery for conjoined twins

CLEVELAND — Surgery to separate twins joined at the head has been permanently called off because the medical risk to the 3-year-old girls is too high, Rainbow Babies and Children’s Hospital said Monday.

While Tatiana and Anastasia Dogaru can develop life-threatening complications if they remain conjoined, the risk of proceeding with the long-planned separation surgery is too great, said Dr. Nathan Levitan, chief medical officer of the hospital’s parent, University Hospitals Case Medical Center.

“We are, of course, worried that the girls could develop complications over time if they are not separated, as have other children with this condition,” he said. “However, in the judgment of our team of physicians, the risk of proceeding with separation is too great.”

CHRONOLOGY
Events in the lives of conjoined twins Anastasia and Tatiana Dogaru:

JAN. 13, 2004
Born in Italy to Romanian parents.

OCT. 2004
Family arrives in Dallas for medical tests.

APRIL 3, 2007
Twins arrive in Cleveland for separation surgery.

JUNE 6, 2007
Complications halt initial surgery in separation.

AUG. 13, 2007
Separation surgery plans canceled.

Source: University Hospitals Rainbow Babies & Children’s Hospital

The decision was made last week after doctors reviewed the results of weeks of tests done on the girls, Levitan said.

The top of Tatiana’s head is attached to the back of Anastasia’s and they have never been able to look each other in the eye. Anastasia, the bigger twin, has no kidney function and relies on Tatiana’s kidneys.

The girls’ were born in Italy to Romanian parents Alin Dogaru, a Byzantine Catholic priest, and his wife, Claudia, who have said they viewed separation surgeries as the girls’ best hope. But the decision to cancel plans complied with their wish to avoid any procedure that could harm either girl.

They said in a videotaped statement played at a Monday news conference at the hospital that they were thankful for the care the girls had received. Claudia Dogaru said she and her husband believe they had made the best decision on behalf of the girls.

Alin Dogaru said the family appreciated the hospital’s consideration of their concern that neither girl face a significant risk.

“We want to thank them, the medical team, for being aware of this and stopping at the right time,” he said.

Levitan, asked about the girls’ survival prospects, said only 14 similar twins have been reported in the past half century, and just 10 percent had reached age 11.

While medicine continues to make progress, “no one can predict the future,” he said.

An initial surgery in the process to separate the twins on June 6 was halted because of brain swelling and low blood pressure.

Medical tests since the aborted surgery showed the hearts of both girls are overworking — Tatiana’s as if to overcome a blockage and Anastasia’s to deal with low blood pressure.

Dr. James Tait Goodrich of New York’s Montefiore Medical Center, who separated conjoined twins in 2004, said the complexity of the Dogaru case made the decision understandable.

“There are a lot of extenuating circumstances here that could have seriously led to the demise of both children or even if they had survived, been in a much more compromised state than they are in now at present,” said Goodrich, who has consulted on the Dogaru case.

The girls arrived in Cleveland on April 3 from Dallas, where they had been evaluated, to begin testing to determine whether they could undergo separation surgery.

Levitan said the risks to the conjoined girls include infection and heart failure.

“These types of problems are very hard to manage,” he said.

The twins have already beaten the odds by living this long. Most twins joined at the head die at birth, according to the hospital.

They are doing well at home, walking and playing, Levitan said.

The hospital is working with the family to decide whether the girls will return to Romania or stay in the U.S., who will provide medical care and who will pay for it.

Levitan said the doctors involved in the case felt they had done the best they could to give the girls a chance to be separated.

“I expect we will all keep in touch with them,” he said.