In less than a month, a multidisciplinary team of surgeons here at Texas Children’s Hospital will embark on what could be a 36-hour procedure to separate 9-month-old conjoined twins, Knatalye Hope and Adeline Faith Mata.
During that time frame, surgeons from 13 subspecialties will conduct a series of well-orchestrated operations on the girls, who share a chest wall, lungs, pericardial sac (the lining of the heart), diaphragm, liver and pelvis. The separation team will start the surgery and the reconstruction team will complete the procedure.
“This is a huge undertaking,” said Dr. Darrell Cass, pediatric surgeon and co-director of Texas Children’s Fetal Center. “There’s been an extensive amount of involvement from many of the departments in the hospital, including radiology.”
With help from a Dallas printing company, Chief of Radiology Research and Cardiac Imaging Dr. Rajesh Krishnamurthy built a 3D model of the twins’ anatomy to help surgeons plan for the girls’ separation. The model was built using a computerized image data set of the twins and a 3D printer.
“It’s very useful for preoperative surgical planning,” Krishnamurthy said of the model. “Especially when it comes to conjoined twins.”
Twins, specifically conjoined twins, tend to have pretty complicated anatomy. In the case of the Mata twins, there is a large part of the body – the chest, the abdomen and the pelvis – that is fused. Having a 3D model of the girls has given surgeons insight into what they are going to encounter.
The model – which goes into a fair degree of detail, including a detachable, transparent liver – has been especially helpful in the planning of the pelvic portion of the surgery, which presents an interesting and challenging anatomical situation in that each girl has her own pelvic organs but each of those organs gets blood supply from each girl.
“We’re going to have to make some real decisions about which bladder goes to which girl, which uterus goes to which girl and which ovaries go to which girl,” Cass said. “That might be the more complex aspect of the operation.”
The 3D model of the twins was created in about a week. The process started with a high-quality computer tomography or CT scan. The image data set was transformed into a 3D segmentation that was color coded and converted into a printable form. That form was sent to Medcad in Dallas where the physical, 3D model was made under the leadership of Dr. Jayanthi Parthasarathy.
In addition to the conjoined twins, 3D modeling at Texas Children’s is regularly done in orthopedic cases, such as in the setting of hip dysplasia or unusual rotational abnormalities of the bone. It’s also used in some congenital heart disease cases and could be used in other areas as well.
“3D modeling is a visual representation of the complexity that surgeons might encounter during a procedure,” Krishnamurthy said. “This is very powerful when you are trying to come up with unique solutions to a particular case.”
Cass said the 3D model is one of many reasons why the Mata twins are at Texas Children’s Hospital.
“The Mata family did their homework,” he said. “They got to know different hospitals and different surgeons and they chose us. We’re incredibly grateful to them for putting their faith and trust in us and we’re very optimistic that we’ve done all the preparation needed to have a very good result.”
Elysse Mata, the twins’ mother, said she is excited about her girls’ upcoming separation.
“I can’t wait to hold two babies and be able to take them home,” she said.
Knatalye and Adeline were born April 11 at Texas Children’s Pavilion for Women. Delivered via Caesarean-section at 31 weeks gestation, the twins each weighed 3 pounds, 7 ounces.
The girls’ parents, Elysse and John Mata, and their 5-year-old brother, Azariah, learned during a routine ultrasound on January 13 that Elysse was carrying twins and they were conjoined. Subsequently, the family was referred from a physician in Lubbock, their hometown, to the Texas Children’s Fetal Center where they underwent extensive prenatal imaging, multidisciplinary consultation and development of plans to achieve a safe delivery and postnatal care.
Now 9 months old, the babies are doing well as they continue to be cared for by a team of specialists in the Level IV Neonatal Intensive Care Unit at Texas Children’s Hospital.