CLEVELAND — Their hopes for separation surgery blocked, the parents of twins joined at the head now face a daunting series of new decisions: where to raise the girls, who will monitor their health and how to pay for medical care.
Rainbow Babies and Children's Hospital, which announced Monday that medical complications have ruled out separation surgery for 3-year-olds Tatiana and Anastasia Dogaru, said they would help the parents as they move forward.
The girls face an uncertain future. For now, they are living in the Cleveland area, playing and walking.
"We are, of course, worried that the girls could develop complications over time if they are not separated, as have other children with this condition," said Dr. Nathan Levitan, chief medical officer of the hospital's parent, University Hospitals Case Medical Center. "However, in the judgment of our team of physicians, the risk of proceeding with separation is too great."
The top of Tatiana's head is attached to the back of Anastasia's and they have never been able to look each other in the eye. Anastasia, the bigger twin, has no kidney function and relies on Tatiana's kidneys.
The girls' were born in Italy to Alin Dogaru, a Byzantine Catholic priest, and his wife, Claudia, who have said they viewed separation surgeries as the girls' best hope. But the decision to cancel plans complied with their wish to avoid any procedure that could harm either girl.
They said in a videotaped statement played at a news conference at the hospital that they were thankful for the care the girls had received.
Alin Dogaru said the family appreciated the hospital's consideration of their concern that neither girl face a significant risk. "We want to thank them, the medical team, for being aware of this and stopping at the right time," he said.
Levitan, asked about the girls' survival prospects, said only 14 similar twins have been reported in the past half century, and just 10 percent had reached age 11.
Medical tests since the aborted surgery showed the hearts of both girls are overworking — Tatiana's as if to overcome a blockage and Anastasia's to deal with low blood pressure.
Dr. James Tait Goodrich of New York's Montefiore Medical Center, who separated conjoined twins in 2004, said the complexity of the Dogaru case made the decision understandable.
"There are a lot of extenuating circumstances here that could have seriously led to the demise of both children or even if they had survived, been in a much more compromised state than they are in now at present," said Goodrich, who has consulted on the Dogaru case.
The girls arrived in Cleveland on April 3 from Dallas, where they had been evaluated, to begin testing to determine whether they could undergo separation surgery.
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