Thursday, September 05, 2002

Twins battled each other, now ready for life apart

Separation surgery leaves both short of skin, one with enlarged heart

By Carrie Spencer
The Associated Press

        COLUMBUS - Twin sisters joined at the chest and abdomen were born hugging but spent the next four months swatting at each other in the nursery, their parents said days after doctors separated the girls in a 13 1/2-hour surgery.

[photo] Shane Heaberlin and Trinda Kaminski visit their daughters before the surgery Wednesday.
(Associated Press photos)
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        Jazmine and MaKayla Heaberlin were in critical but stable condition in separate rooms Wednesday at Children's Hospital.

        The girls had shared a liver and the membrane that surrounds the heart, but had independent hearts close to each other. The liver can grow back when separated into lobes.

        “They were together so long, they don't know what to think,” their mother, Trinda Kaminski, said at a news conference.

        Originating from a single fertilized egg, conjoined twins occur when the developing embryo starts to split into twins but stops before the split is complete.

        Only a few hundred pairs are born each year around the world. Conjoined twins occur roughly once in every 200,000 live births in the United States.

        The girls' father, Shane Heaberlin, 23, said he cried when he heard that Friday's operation to separate his daughters was successful. The couple lives in Mansfield, midway between Columbus and Cleveland.

[photo] Conjoined twins Jazmine and MaKayla Heaberlin
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        Ms. Kaminski, 19, said she was six months pregnant in February when she learned from her first ultrasound that she was having twins and they might be conjoined. The diagnosis was confirmed at Ohio State University Medical Center.

        “I had all my news at once,” Ms. Kaminski said. “I was excited when I found out I was having twins. Then I found out they were conjoined. I was happy and I was devastated.”

        The twins were delivered by Caesarean section at OSU on April 24, about two months early. Together they weighed 8 pounds, 4 ounces, and had grown to a combined 19 pounds by the time of Friday's surgery.

        “These twins spent about 100 percent of their time prior to separation fighting and boxing with each other,” said Dr. Gail Besner, a pediatric surgeon and one of the leaders of the separation team.

        Ms. Kaminski said they were constantly moving and kicking even in the womb. “They're always up, and fighting,” she said.

        MaKayla might be ready to go home in a month, Dr. Besner said.

        However, Jazmine faces a more difficult recovery because there is a hole in her heart that doctors must someday repair.

        The problem probably would have hurt long-term survival if the girls weren't separated, Children's spokeswoman Pam Barber said.

        Doctors were fairly certain before the twins were born that they could be separated, Dr. Besner said. The actual separation took about two hours, which is uncommonly short, she said.

        The hard part was closing the 4-inch-wide oval opening on the twins' abdomens. Doctors had to insert tissue expanders so the girls would grow more skin before the operation. There was enough skin to close MaKayla's chest, but not Jazmine's.

        Part of the problem is that Jazmine's heart is enlarged.

        “It would not fit in the confines of her chest,” said Dr. Terry Davis, a specialist in heart and chest surgery.

        The surgical team used titanium mesh - which looks much like the mesh on a screen door, Dr. Davis said - lined with Gore-Tex surgical fabric to create a dome around Jazmine's heart cavity.

        Future operations are needed to better protect the heart and to close the opening with her own skin, doctors said. The twins also lack breastbones, which could require more surgery.

        The girls were the fourth set of conjoined twins to be successfully separated at Children's since the first in 1978 - males who have since graduated from college. Two other sets born there died shortly after birth.

        In September 2000, a team of 40 surgeons separated Decontee and Mary Cole, who were born in Liberia with fused backbones and buttocks. They're still living in Columbus with their parents and are able to walk, Ms. Barber said.

        Another set of conjoined twins born to an Ohio couple on Aug. 16 cannot be separated because they share both a heart and liver, doctors at Children's Hospital in Pittsburgh said last week.

        Ms. Kaminski said they've heard of many such cases.

        “We were so lucky,” she said. “I wish everyone else could be like us.”

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