Conjoined twins separated at Packard Children's Hospital

Courtesy of Packard ChildrenÂ’s Hospital

Two-year-old twins Yurelia and Fiorella Rocha-Arias were embraced by their mother, Maria Elizabeth Arias, after they came from Costa Rica to Packard Hospital. Surgery to separate the twins took place Nov. 12.

Surgeons at Lucile Packard Children's Hospital separated 2-year-old conjoined twins from Costa Rica on Nov. 12 in a nine-hour procedure.

As previously announced to the media in September, Yurelia and Fiorella Rocha-Arias had been joined at the abdomen and chest. They shared a liver and the right atriums of their hearts were connected.

"The separation is the culmination of months of planning by several multidisciplinary teams," said lead surgeon Gary Hartman, MD. "It was a very risky and complicated surgery, and the outcome is still unknown. The girls face many more hurdles in their path to recovery."

Hartman had estimated the chance of both girls surviving the initial surgery successfully at 50 percent. One more hurdle will occur later this week when cardiothoracic surgeon Frank Hanley, MD, attempts to correct a serious heart defect in Yurelia, who was born with a condition known as double outlet right ventricle, or DORV.

The separation was complicated by the fact that the twins shared a blood supply. The fusion of the hearts and the shared liver also made it uncertain as to how each girl's circulatory system would function alone. Many of these concerns were allayed during surgery, which began at 6:30 a.m. and ended at 3:30 p.m. "The separation went much better than anticipated," said Hartman. "Dozens of people worked together seamlessly, and the girls' cardiac function actually improved when they were separated."

Each child had her own medical team during the procedure. The twins' liver was separated at about 10:30 a.m. and their hearts were separated around 11:30 a.m. The girls themselves were completely separated by around noon. They were moved to separate rooms for reconstructive surgery after they were separated. Two comprehensive care teams—one for each girl, with representatives from nursing, anesthesia, cardiothoracic surgery, pediatric general surgery, plastic surgery, cardiac bypass and others—were in the operating rooms throughout the entire procedure. "It was an extraordinary team effort," said Hartman, adding that one onlooker compared the activity in the operating room to a symphony.

Yurelia and Fiorella are currently under the care of the hospital's critical care teams, and are with their thankful parents Maria Elizabeth Arias and José Luis Rocha. "We want to thank Mending Kids International, Costa Rica and Lucile Packard Children's Hospital for prayers, guidance and support," said the twins' mother, Arias.

For frequently asked questions and more information, visit http://twins.lpch.org.

Gifts in support of Packard Children's Hospital and the expert care it gives to children like Yurelia and Fiorella can be made by visiting http://twins.lpch.org and clicking the "How to Help" link.