ABSTRACT
This topic is beyond the scope of this chapter. See the excellent review by Winston et al. for further information.7
The separation of conjoined hearts is difficult and carries an extremely high morbidity and mortality rate.1 The usual anomaly is one of junction at the ventricle, resulting in a six-chambered heart with insufficient cardiac tissue for long-term maintenance of both twins. Limited success has been reported for separation of one pair of twins joined at the atria. In most cases, one infant is given the entire cardiac complex in order to have some chance of survival. Extensive intraoperative reconstruction is frequently necessary. One technique that may have promise in the future is cardiac excision, intraoperative ex vivo reconstruction, and subsequent autotransplantation. Another alternative that may hold some promise of salvaging both twins is that of cardiac transplantation of one infant and reconstruction of the heart of the other.
