The Little Marias
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Jorge Lazareff (left) and plastic and reconstructive surgeon
Henry Kawamoto (right) discuss the girls' positioning on the
difficulty was that we had two patients who were attached and who
shared venous cerebral circulation, which means when we gave drugs
to one, it affected the other," Van de Wiele, director of neurosurgical
anesthesiology, continues. "That's a very unique circumstance."
The team learned this before the girls' first angiogram, shortly
after they arrived at UCLA. They gave Maria de Jesús the
drug Atropine, which increases the heart rate, and within seconds
Maria Teresa's heart rate also increased. For the surgery, General
Electric Co. provided two extra monitors so that each twin's anesthesia
team could see the vital signs of both girls simultaneously and
pick up on any trends.
the twins also is critical. Prior to the operation, the medical
team, working with plastic molds of the girls' heads that had been
cast and donated by Biomedical Modeling Inc. of Boston, at a cost
of $10,000, spent many hours figuring out how best to position the
children so the surgeons could work on both simultaneously without
having to move them or turn them over during the operation. They
also wanted them properly positioned so that at the moment of separation
they could rotate the tables apart and the two plastic-surgery teams
could immediately start work on each of the girls.
with such preparation, the team has to improvise when it comes time
to do the actual surgery. "Positioning is really what this
whole case is about," Van de Wiele says. "And it really
takes teamwork between the surgical, nursing and anesthesia teams
to achieve optimal positioning."
the girls are secured and their thick, black hair is shaved off,
Kawamoto and his team set to work mapping out their approach, using
a high-tech Doppler ultrasound wand and a low-tech black Sharpie
marker to draw a line around the girls' scalp where the incisions
will be made.