Fig 712

percent of the surviving twins are joined at the chest, face to face, looking each other in the eye (Fig. 7.12). They are called "tho racopagus twins." (Thoraco refers to the chest; pagus is a Greek word meaning fixed). Thoracopagus twins may also be joined at the abdomen down to the pubis. They may share a common liver, intestines or even a heart.

For pediatric heart and thoracic surgeons, the division of thoracopagus children ranges from extremely challenging to outright impossible with today's knowledge. My experience in one case with Koop, the chief pediatric surgeon, and Dr. L. Henry Edmunds, Jr., the chief heart surgeon at the University of Pennsylvania, involved a set of Siamese twins with only one heart between them. Before the surgery could be done, the children had to be taken to the operating room and the procedure mapped out ahead of time, position by position, turning them in different ways for each incision. The surgery was considered a success even though we were able to save only one child, but generally success in this very complicated field has been limited. Twin separation remains a challenge for the pediatric surgical community.

Fig. 7.12: Conjoined Twins:

Commonly referred to as "Siamese twins," these are a set of twins who are joined at some place on their bodies, including at the chest.

Coronary artery disease is caused by atherosclerosis. During this process, plaque builds up in healthy arteries and gradually clogs them.

CHAPTER EIGHT

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