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CNN Live Today
Twins' Operation Historical Despite Outcome
Aired July 08, 2003 - 10:01 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
LEON HARRIS, CNN ANCHOR: And we're going to begin this hour with a sad development in a story that we've been following for some time now. Twin Iranian sisters Ladan and Laleh Bijani lived their dream but for only a short time. Both of them died after surgeons separated the women who said that they accepted the risk of death all in order to end a lifetime of being joined at the head. Now all along doctors had been saying that each woman face only a 50 percent chance of survival if this operation did succeed.
Now, let's get some more perspective on the complexities of the surgery and a look back at what happened. We turn to our medical correspondent Dr. Sanjay Gupta who has been following this...
(CROSSTALK)
DR. SANJAY GUPTA, CNN MEDICAL CORRESPONDENT: Well interesting. And you know there was really nothing to compare this particular case to because this was the first time it had ever been done, that is separation of conjoined twins in the adults.
And we have been following the story for quite some time. Some of the early obstacles that we had been talking so much about, specifically creating another vein for one of the twins, they actually got through that part of the operation OK.
But, Leon, after talking to the doctors, hearing from them earlier today, it sounds like one of these blood vessels probably developed a blood clot inside of it and thus was not allowed to drain the brain of its blood supply anymore and the brain started to get swollen, started to bleed. All of this in the face that the fact that these twins were likely on these blood thinning medications as well.
Listen, decisions were made all along here. Decisions were made obviously before the operation. Decisions were also made during the operation. Leon, imagine if you will, coming to a point where you recognize things are not going well, it might be safer to go ahead and stop rather than to continue. That was the exact decision that doctors had to face. And this is what they said about it during the news conference earlier today.
(BEGIN VIDEO CLIP)
DR. KEITH GOH, NEUROSURGEON: The team wanted to know once again what are the wishes of Ladan and Laleh. And we were told that Ladan and Laleh's wishes were to be separated under all circumstances.
(END VIDEO CLIP) GUPTA: Circumstances here meant unfortunately they both died.
HARRIS: And the thing is, you and I talked barely 24 hours ago, right about this time. And you said, you told us then that even though they had successfully gone ahead and made the separation between the brains and they had rebuilt or constructed that blood vessel, that may have been the trickiest part but that was not the end of the risk. You said that yourself just yesterday.
GUPTA: That's right. Because they actually took a vein from the leg of one of the twins and actually used that in the brain. Surgeons always worry that particular blood vessel may, in fact, block itself off, develop blood clots inside of it. They actually had to start these blood thinners which could be a precarious situation as well.
You know, we also had a chance to talk to Dr. Ben Carson who we've been talking about so much. He's a neurosurgeon from Johns Hopkins who went out there as well. And asked him, You know, this is a tough decision to make to subject, to possibly subject these women to these risks for an elective operation. This is what he had to say.
(BEGIN VIDEO CLIP)
GOH: They undertook this challenge. We knew the risks were great. We knew that one of the scenarios was we may lose both of them. Ladan and Laleh knew it too. We were hoping and trying to do better than the worst (UNINTELLIGIBLE). But alas, we didn't make it.
(END VIDEO CLIP)
GUPTA: And I will say that was not Dr. Ben Carson, but sort of the same words from Dr. Ben Carson as well.
They knew the risks going in.
HARRIS: Well let me ask you something here. We've been talking about this throughout this entire process. From the first day this story broke about the differences between children, as we've seen who have been separated in the past, most notably, recently in L.A. at the medical center there, Cedar Sinai i think it was, we have we saw that happen and you drew plenty of distinctions between the child going through this process and an adult.
Now, does this experience now lead doctors, and perhaps neurosurgeons like yourself to say maybe we shouldn't try this with adults?
GUPTA: I think you bring up a good point because it's interesting both from a medical standpoint as well as a historical standpoint.
Medically I think there are a lot of differences. Adults don't rebound as well from operations like this. The simple thing like cutting through the bone is harder in adults. Working with these blood vessels all more challenging. But you think even more historically now, Leon, I think we may never see something like this again. And here's the reason why. Because I think medical technology has gotten to the point now where if someone is born -- if twins are born conjoined they're going separate them at birth.
When the Bijani twins were born almost 30 years ago they didn't have that technology. Certainly not in Iran. And that's part of the reason they weren't separated back then. So it may be we don't see adult conjoined twins actually undergo this procedure.
There are more than a dozen or so that are alive in the world today and I'm sure they're watching the progress of the Bijani twins very closely. They may say we're not going to go and have this operation ourselves and anybody else that is born will have it done at birth.
HARRIS: Very interesting. Lots of things that medical community has learned from this experience.
GUPTA: Absolutely.
(CROSSTALK)
HARRIS: ... best thing about it. And these two ladies' lives will have gone on to maybe help many more lives.
GUPTA: Historical no matter what the outcome. Absolutely.
HARRIS: Thanks. Dr. Sanjay Gupta here with a great expertise, advice and insight throughout this entire story from start to finish.
TO ORDER A VIDEO OF THIS TRANSCRIPT, PLEASE CALL 800-CNN-NEWS OR USE OUR SECURE ONLINE ORDER FORM LOCATED AT www.fdch.com
Aired July 8, 2003 - 10:01 ET
THIS IS A RUSH TRANSCRIPT. THIS COPY MAY NOT BE IN ITS FINAL FORM AND MAY BE UPDATED.
LEON HARRIS, CNN ANCHOR: And we're going to begin this hour with a sad development in a story that we've been following for some time now. Twin Iranian sisters Ladan and Laleh Bijani lived their dream but for only a short time. Both of them died after surgeons separated the women who said that they accepted the risk of death all in order to end a lifetime of being joined at the head. Now all along doctors had been saying that each woman face only a 50 percent chance of survival if this operation did succeed.
Now, let's get some more perspective on the complexities of the surgery and a look back at what happened. We turn to our medical correspondent Dr. Sanjay Gupta who has been following this...
(CROSSTALK)
DR. SANJAY GUPTA, CNN MEDICAL CORRESPONDENT: Well interesting. And you know there was really nothing to compare this particular case to because this was the first time it had ever been done, that is separation of conjoined twins in the adults.
And we have been following the story for quite some time. Some of the early obstacles that we had been talking so much about, specifically creating another vein for one of the twins, they actually got through that part of the operation OK.
But, Leon, after talking to the doctors, hearing from them earlier today, it sounds like one of these blood vessels probably developed a blood clot inside of it and thus was not allowed to drain the brain of its blood supply anymore and the brain started to get swollen, started to bleed. All of this in the face that the fact that these twins were likely on these blood thinning medications as well.
Listen, decisions were made all along here. Decisions were made obviously before the operation. Decisions were also made during the operation. Leon, imagine if you will, coming to a point where you recognize things are not going well, it might be safer to go ahead and stop rather than to continue. That was the exact decision that doctors had to face. And this is what they said about it during the news conference earlier today.
(BEGIN VIDEO CLIP)
DR. KEITH GOH, NEUROSURGEON: The team wanted to know once again what are the wishes of Ladan and Laleh. And we were told that Ladan and Laleh's wishes were to be separated under all circumstances.
(END VIDEO CLIP) GUPTA: Circumstances here meant unfortunately they both died.
HARRIS: And the thing is, you and I talked barely 24 hours ago, right about this time. And you said, you told us then that even though they had successfully gone ahead and made the separation between the brains and they had rebuilt or constructed that blood vessel, that may have been the trickiest part but that was not the end of the risk. You said that yourself just yesterday.
GUPTA: That's right. Because they actually took a vein from the leg of one of the twins and actually used that in the brain. Surgeons always worry that particular blood vessel may, in fact, block itself off, develop blood clots inside of it. They actually had to start these blood thinners which could be a precarious situation as well.
You know, we also had a chance to talk to Dr. Ben Carson who we've been talking about so much. He's a neurosurgeon from Johns Hopkins who went out there as well. And asked him, You know, this is a tough decision to make to subject, to possibly subject these women to these risks for an elective operation. This is what he had to say.
(BEGIN VIDEO CLIP)
GOH: They undertook this challenge. We knew the risks were great. We knew that one of the scenarios was we may lose both of them. Ladan and Laleh knew it too. We were hoping and trying to do better than the worst (UNINTELLIGIBLE). But alas, we didn't make it.
(END VIDEO CLIP)
GUPTA: And I will say that was not Dr. Ben Carson, but sort of the same words from Dr. Ben Carson as well.
They knew the risks going in.
HARRIS: Well let me ask you something here. We've been talking about this throughout this entire process. From the first day this story broke about the differences between children, as we've seen who have been separated in the past, most notably, recently in L.A. at the medical center there, Cedar Sinai i think it was, we have we saw that happen and you drew plenty of distinctions between the child going through this process and an adult.
Now, does this experience now lead doctors, and perhaps neurosurgeons like yourself to say maybe we shouldn't try this with adults?
GUPTA: I think you bring up a good point because it's interesting both from a medical standpoint as well as a historical standpoint.
Medically I think there are a lot of differences. Adults don't rebound as well from operations like this. The simple thing like cutting through the bone is harder in adults. Working with these blood vessels all more challenging. But you think even more historically now, Leon, I think we may never see something like this again. And here's the reason why. Because I think medical technology has gotten to the point now where if someone is born -- if twins are born conjoined they're going separate them at birth.
When the Bijani twins were born almost 30 years ago they didn't have that technology. Certainly not in Iran. And that's part of the reason they weren't separated back then. So it may be we don't see adult conjoined twins actually undergo this procedure.
There are more than a dozen or so that are alive in the world today and I'm sure they're watching the progress of the Bijani twins very closely. They may say we're not going to go and have this operation ourselves and anybody else that is born will have it done at birth.
HARRIS: Very interesting. Lots of things that medical community has learned from this experience.
GUPTA: Absolutely.
(CROSSTALK)
HARRIS: ... best thing about it. And these two ladies' lives will have gone on to maybe help many more lives.
GUPTA: Historical no matter what the outcome. Absolutely.
HARRIS: Thanks. Dr. Sanjay Gupta here with a great expertise, advice and insight throughout this entire story from start to finish.
TO ORDER A VIDEO OF THIS TRANSCRIPT, PLEASE CALL 800-CNN-NEWS OR USE OUR SECURE ONLINE ORDER FORM LOCATED AT www.fdch.com
