ABSTRACT
We describe the anaesthetic management of a pair of thoracopagus twins of 14 months of age undergoing complex cardiac evaluation. Synchronous ventilation of the twins, needed for the ECG-gated magnetic resonance imaging-angiography, was achieved through a Carlens (Y) adaptor during procedures and transport. The complex logistical implications are obvious. We also describe the first use of bispectral index monitor for detection of cross-circulation in conjoint twins.
Subject(s)
Anesthesia, General/methods , Diseases in Twins/diagnosis , Heart Defects, Congenital/diagnosis , Respiration, Artificial/methods , Twins, Conjoined/physiopathology , Coronary Circulation , Cross Circulation , Electrocardiography , Humans , Infant , Magnetic Resonance Angiography/methods , Male , Monitoring, Physiologic/methods , Respiration, Artificial/instrumentationABSTRACT
We describe two distinct cases in which discontinuous pulmonary arteries were identified by echocardiography and color Doppler imaging. In both cases, perfusion of one or both pulmonary arteries was dependent on a patent ductus arteriosus. Establishment of the source of perfusion and the anatomy of the discontinuous pulmonary arteries were evident only after an infusion of prostaglandin had been initiated, thus demonstrating that its use was a key component in the identification of this disease entity.
