PALO ALTO, Calif-- Lucile Packard Children's Hospital at Stanford has announced that formerly conjoined twin Yurelia Rocha-Arias underwent successful cardiac surgery Wednesday (14) to correct a life-threatening congenital anomaly known as double outlet right ventricle (DORV). Yurelia and her twin Fiorella, who were previously separated in a 9-hour surgery Monday (12), are now recovering in the hospital’s cardiovascular intensive care unit. In another milestone for the Costa Rican twins, Fiorella has been extubated and is breathing on her own.
 
“It went really well,” said cardiothoracic surgeon Frank Hanley, MD, of the 6-hour correction and reconstruction. “Yurelia’s heart condition should now be completely fixed.” Hanley is the hospital’s chief of pediatric cardiothoracic surgery and an internationally-known specialist in treating complex congenital heart defects in kids. 
 
DORV occurs early in pregnancy when the heart is developing. In children with DORV, both the pulmonary artery and the aorta are connected to the right ventricle. In a normal heart the aorta is connected to the left ventricle and delivers oxygenated blood throughout the body. Kids with DORV have trouble getting enough oxygen to their tissues and their hearts must work abnormally hard to support life.
 
For Wednesday’s repair, Hanley created a tunnel from the left ventricle through the right ventricle to the aorta to correct the flow of blood in Yurelia’s body. The tunnel passed through and sealed a hole between the sides of Yurelia’s heart that had allowed mixing of oxygen-rich and oxygen-poor blood. Hanley also widened an area in Yurelia’s heart near the pulmonary valve that had been constricting the flow of blood to Yurelia’s lungs. Because Yurelia and Fiorella were joined at the chest and abdomen and their hearts were connected, it was impossible to correct Yurelia’s DORV before the twins were separated. The surgeons delayed Yurelia’s cardiac correction until Wednesday in order to reduce the risk of bleeding from the anti-clotting medication used when patients are placed on a heart-lung bypass machine in preparation for open-heart surgery.
 
The surgery was complicated by the fact that the connection between the girls caused Yurelia’s heart to become abnormally positioned in her chest. “Although it will never resemble a normal heart, it should still function properly,” said Hanley.
 
“We are very happy with the outcome so far,” said Gary Hartman, MD, who was the lead surgeon in Monday’s separation. “These are two very strong little girls.” After Hanley corrected Yurelia’s heart defect, Hartman and pediatric plastic surgeon H. Peter Lorenz, MD, reconstructed Yurelia’s chest wall. Meanwhile, there’s other good news. “The twins have been handling anesthesia well,” said pediatric cardiac anesthesiologist Gail Boltz, MD, who led a team of five anesthesiologists keeping the twins comfortable through Monday’s extraordinary separation.
 
For the immediate future, doctors in the cardiovascular intensive care unit are continuing to closely monitor the girls’ progress. “All in all, the twins’ condition is about what we expected to be and there are no surprises,” said cardiovascular intensive care physician Gail Wright, MD. Mom Maria and dad José Luis have remained bedside with the girls throughout this amazing week. “The prayers, the guidance, the support and the care all mean so much to us and our family,” said Maria. “We have so many to thank and so much to be thankful for.”
 
For frequently asked questions and more information, visit http://twins.lpch.org. Gifts in support of Packard Children’s Hospital and the expert care it gives to children like Yurelia and Fiorella can be made by visiting http://twins.lpch.org and clicking the ‘How to Help’ link. To find out more about Mending Kids International, visit http://www.mendingkids.org.