Return to Transcripts main page

CNN Live Today

Answers to Questions About Formerly Conjoined Twins

Aired August 08, 2002 - 11:32   ET

THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.

LEON HARRIS, CNN ANCHOR: All this week, the nation has been following the story of those two little Marias that are conjoined, or formerly conjoined twins that were successfully separated.
DARYN KAGAN, CNN ANCHOR: The story is the focus of our "Paging Dr. Gupta" segment. I got to say, I'm looking at some of the e-mail questions that people sent in, they are excellent.

HARRIS: Good questions, same kinds of questions we have been talking about here in the studio with Dr. Sanjay Gupta, who you see there on the screen with us. He was here with us last hour. He is back here now to give us some answers to all the e-mail questions that we've gotten in. And as you see, we have got plenty of them.

KAGAN: All right, lets bring him back.

Hi, Sanjay.

DR. SANJAY GUPTA, CNN MEDICAL CORRESPONDENT: Hi, Daryn.

KAGAN: All right, here comes the first question: "What did they use to cover the large area that was left open in the girls' skulls after the surgery. And that's from George, Hatfield, Pennsylvania.

GUPTA: Right, I'll tell you, a lot of interest in this particular area, certainly after getting done with the operation, separating the veins, the surgeons still had a lot of work to do, and still have a lot of work to do. There are still operations to come.

But let me give you a brief sort of explainer on how they cover both bone and skin. First of all, I want to get the image of the...

KAGAN: Here comes the props, huh?

GUPTA: Yes, right, props and pictures. We have got some pictures of the girls here, and you'll see. I don't know if you can actually tell with this picture. Here we go. When they are moving, you see there is a balloon implanted underneath their skin before. Look at part of the right in here. And that is a balloon under the skin. There you go. You see it better there.

HARRIS: There you go.

KAGAN: There actually was a complication with that, wasn't there?

GUPTA: There was. They actually implanted two of them in both Maria's heads, and one of them actually tore, the skin tore above the balloon, but the purpose of that -- and you can see there is actually hair growing over. The hair has been shaved. That's important, because that skin is actually stretched over the new defect or wound from the operation, and That's what they use for the skin.

As far as the bone goes, the bone is really interesting as well. Here is one of the props, you will appreciate. This is the skull. This gives you a good idea.

KAGAN: And old friend of yours, Sanjay.

GUPTA: And old patient, right. I'm going to rotate it around, and you see the back of the head now, an the operation actually took place in this area over here. What they actually had to was really remarkable. They operated really on the whole skull and took bone from other places around the skull, and actually covered up the important areas that they wanted to cover up now, including middle part of the brain and some of the side parts of the brain, but there are large soft spots in the brain still today. They will come back later operations and actually take additional bone when the babies have thick enough bone, split that bone in half, and cover up the rest of the soft spots. That may be an operation done months down the line.

But that is basically how they plan on covering up the bone and skin.

HARRIS: We talked about that the other day. We were talking the other day shaving it is pretty much like shaving it in half.

GUPTA: Almost like trying to shave a piece of paper in half, not an easy thing do.

HARRIS: That's amazing.

Let's get to the next one. This one is coming in from Sheldon in Huntington Beach. "In recent days, I have been hearing about 'conjoined twins.' Is this the current designation for 'Siamese twins," or are the two not the same?"

GUPTA: Conjoined twins is the current designation, the medically current designation. Siamese twins came about from probably the most famous set of conjoined twins, Chang and Ang Bunker, actually from what is from what is now Thailand, then Siam, and they actually were conjoined at the chest area, and lived to be 63 years old. They were very famous here in this country for a long time, but that's sort of where that term came into vogue. But conjoined twins is the name to use.

HARRIS: Very successful businessmen, too, as I recall.

GUPTA: That's right.

KAGAN: Our next question comes from Debbie in Cape Coral, Florida. She want to know, Sanjay, "Do you have any idea how long it will be before the twins will be taken off the ventilators?" GUPTA: You know, it was a long operation, and still, both the twins are getting pain management medications up until now. Sometimes these medications can actually interfere with how well they would breath on their own without the ventilator. What I'm saying, in part, they are still on the ventilator because of the operation. And in part, they're on the ventilator because they're given medications that make them very sleepy. So it could be a few days still before they come off that, before they are awake enough, before their pain is controlled enough to come off the ventilator. One of the twins opened their eyes today. That is certainly a good sign.

HARRIS: Here is another question I think is very interesting. "The brains of such conjoined twins, are they linked in such a way that their bodies actually operate as single system? Is such phenomenon thus programmed into their entire being from birth?" That's from Meg i Freemansburg.

GUPTA: Yes, that is an excellent question. Let me point out a couple of things. First, with particular case, I think we have a picture of the MRI scan, and I want to point out something very important with these particular two Marias. Follow this black line along the middle of the brain. You will see that there is a separation between the two brains.

So while they are truly conjoined, no doubt about it looking at the picture, the brains are separate. They had two independent thoughts. One would be asleep, one would be awake. One would be laughing, one would crying. So very different systems in terms of their overall brain functioning.

But having said this, there is no question in the past, there have been Siamese twins who have shared organs, even shared a heart. In those situations, it's been really impossible to separate them and have both of them survive, obviously with just one heart.

But with these two twins, independent thoughts, independent brains, probably independent twins now after the operation.

KAGAN: So why the possibility of brain damage if their brains weren't linked, if that wasn't a problem getting the brains apart.

GUPTA: The biggest concern here with this operation, Daryn, good point is that you actually have to manipulate those blood vessels. Those vessels actually, one of the big blood vessels actually went from Maria number ones head to the back of Maria two, and vice versa. When you do that, sometimes the blood will actually build up in the brain, and that can cause stroke-like symptoms. That's the first reason people are concerned about brain damage. The second reason is you still have to operate on the brain, and we can see in that picture there, you still have to operate and split that. That requires manipulating the brain, pushing the brain apart a bit. That can cause some temporary brain damage probably with these kids.

HARRIS: All right, we've got to get to this last question. This is a good one, Sanjay. It's at the root of the whole thing. "What specific genetic malfunctioning can lead to the birth of conjoined twins? Can this be prevented or known shortly after fertilization?

GUPTA: It's an excellent question. Everyone knows conjoined twins are a very rare thing, one in 50,000 to 60,000 births. What would have happened is these would have normally been normal twins, except for one thing, they didn't split until after 12 days of conception. So you look at post-conception day 12, the twins still haven't completely split. If that happens, almost surely the twins will share something. In this case, part of the head, part of the brain. In other cases, liver, heart, something like that. But that is really the genetic thing. You can screen for that. Since it's so rare, it's not something that is commonly done.

HARRIS: Right, boy, fascinating. Thanks, doctor. We appreciate the advice. And, folks, thanks for e-mails. Wish we could get to more.

KAGAN: Good job. We have smart viewers. Good job. Thanks, Sanjay.

GUPTA: Thank you.

TO ORDER A VIDEO OF THIS TRANSCRIPT, PLEASE CALL 800-CNN-NEWS OR USE OUR SECURE ONLINE ORDER FORM LOCATED AT www.fdch.com