Definition of inseparably fused ventricular myocardium in thoracopagus: Fetal echocardiographic utility and pathologic refinement

David Alan Danford, Bruce M. McManus, Stephen M. Nielsen, Michael G. Levine, Howard William Needelman

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Correlative echocardiographic and pathological findings in a thoracopagus with conjoined hearts are reported. One twin had tricuspid atresia with discordant atrioventricular connections and concordant ventriculoarterial connections. The morphologic right ventricle was hypoplastic and there was a large muscular ventricular septal defect. The other twin had hypoplasia of the mitral valve anulus and left ventricle with double-outlet right ventricle and pulmonary valve atresia. The tricuspid valve was severely insufficient in part because of a large orifice and redundant, elongated leaflets with abnormal chordal attachments. The left ventricles of these two twins shared a perforated common "free wall" with at least two large defects allowing mixing of the circulations at that level. Not all anatomic details were established conclusively by fetal echocardiography; however, sufficient diagnostic information was obtained to support a decision not to aggressively resuscitate these twins after elective cesarean delivery at 31 weeks' gestation.

Original languageEnglish (US)
Pages (from-to)242-246
Number of pages5
JournalPediatric Cardiology
Issue number4
Publication statusPublished - Oct 1 1993



  • Congenital heart disease
  • Fetal echocardiography
  • Thoracopagus

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health
  • Cardiology and Cardiovascular Medicine

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