Surviving Twin Is Improving, Doctors Say

Sarah Morales, the surviving infant from Saturday’s delicate surgery to separate Siamese twins, was in stable and improving condition Sunday, but will be watched closely for postoperative complications, doctors said.

With the family’s consent, skin and bone from Sarahi, the twin who did not survive, may be used to permanently close the gaping hole left in Sarah’s abdomen and chest by the five-hour operation at Children’s Hospital here. Her chest is being held together by tissue from a cow’s heart, a common procedure with infants.

“Obviously there are always dangers,” said Dr. John Lamberti, the chief cardiac surgeon, “but if Sarah continues to make progress in 10- to 12-hour segments, I think she’ll be fine.”

In the hours after the operation, and after Sarahi had died suddenly of cardiac arrest, Sarah experienced breathing problems and was given ventilator treatment in the intensive care unit where she remains, Lamberti said.

The twins, born Jan. 12 in Tijuana to the wife of a car mechanic, had been joined at the abdomen, chest and liver. Three main arteries connected their hearts.

Doctors had known that Sarahi’s chances for survival were slim because of her deformed heart but were buoyed when, after the babies were separated, her heart seemed stronger than expected. She died within an hour of leaving the operating room.

“We knew the odds were long,” Lamberti said, “but we went into the surgery with a plan we thought could work.”

The twins’ parents, Maria Luisa Espinoza, 33, and Miguel Angel Morales, 30, were with the babies when Sarahi went into cardiac arrest. Doctors labored to revive her, but she was declared dead 20 minutes later as her parents collapsed in grief.

Although disappointed at Sarahi’s death, doctors Sunday noted that without the surgery, both twins would have died because Sarahi’s heart was taxing Sarah’s. Dr. Michael Segall, director of neonatology, said he thought that they would have died within 10 days. Medical journals say 60% of conjoined twins are stillborn and most others die within days.

Sarah is expected to remain in Children’s Hospital for several weeks. After visiting her Sunday morning, her parents returned to Tijuana to make funeral plans for Sarahi. A San Diego mortuary has offered its services without charge.

The operation was the first time in the hospital’s 41-year history that an attempt has been made to separate conjoined twins.