The saga of Siamese twins who were born and separated last week at the Johns Hopkins Children's Center began to unfold in January when a hospital technician in Washington turned pale.
"Twins again?" Dr. Evelyn Karson of the Columbia Hospital for Women asked innocently, spotting a stunned technician who had just seen the babies on an ultrasound screen.
"Well, sort of."
The first prenatal viewing, which took place just eight weeks after conception, showed two fetuses that appeared to be joined by skin, bone, muscle, and liver tissue at the abdomen and chest. Upon learning this, the expectant mother was shocked but was soon relieved to hear some good news.
The twins had separate hearts, giving them an excellent chance of surviving a surgical separation.
Yesterday, elated doctors from both hospitals gathered at Hopkins with 8-day-old Abigail and Bella Maria Varela and their relieved parents. Surgery revealed that the girls had been joined in the most benign way possible, sharing not a shred of liver tissue. No vital organs whatsoever.
Abigail, however, suffers from a serious heart abnormality that will require three operations to correct. Doctors do not believe that the problem is related to the fact that she and her sister were conjoined.
"The outlook for both girls is very, very good," said Dr. Jean Kan, acting director of pediatric cardiology at Johns Hopkins. "They are going to be normal."
Dr. Paul Colombani, director of pediatric surgery, said the operation lasted just 90 minutes. Twenty-seven surgeons, anesthesiologists, nurses and technicians crowded into one operating room, but used two once the twins were divided. This way, the girls could be stitched and monitored in separate quarters.
Like football players, some people wore the letter "A" on their scrubs while other wore "B" to indicate whether they were assigned to Abigail or Bella Maria.
Doctors placed each girl on her own ventilator and anesthesia. The separation itself took only 30 minutes. It took another hour to close their surgical wounds and monitor vital signs.
Surgeons fashioned each baby a cosmetic navel because the girls shared an umbilical cord. The twins did not need any skin grafts, and the only evidence they were ever joined is a 3-inch surgical wound running from navel to breastbone, said Dr. Colombani.
The girls will probably go home later this week, but plans call for Abigail to return to Hopkins for her heart operations.
Abigail's heart abnormality would probably result in fatal complications if left alone, Dr. Kan said. Fortunately, she said, the defect is not difficult to correct. The first of three heart operations could take place in three or four weeks.
While a normal heart is divided into two upper chambers and two lower ones, Abigail's has just one lower chamber, or ventricle. This occurred because the ventricle lacks a septum, the wall that normally separates the chamber into two.
Without surgery, Abigail's heart would flood the lungs with blood, inflicting severe stress on both organs. In contrast, Bella has a septum that leaks, a problem that doctors say will probably disappear without surgery as tiny perforations heal.
Statistically, the heart problem is more common among identical twins whether or not they are conjoined. The cause is unknown.
Identical twins occur when a single embryo splits into two. Conjoined twins, which result from the incomplete separation of identical twins early in fetal development, occur just once in every 100,000 births.
The Varelas were the third pair of conjoined twins separated at Hopkins in 11 years.
Yesterday's news briefing was also a time for bonding, as 2 1/2 -year-old Dalia Varela got her first chance to meet her little sisters. As cameras flashed and crook-necked reporters gazed, Dalia inspected and laughed in amazement. The infants did what infants do best -- sleep.
The parents, Elva Varela, 38, and Edwin Marroquin, 26, are Guatemalan immigrants who came to this country about a decade ago. Both live in Washington. Ms. Varela is a housekeeper, and Mr. Marroquin a lifeguard. "Our oldest daughter was needing a sister or a brother and we wanted to give her one," said Mr. Marroquin. "We wanted to give her one baby but ended up with two."
Mrs. Varela said that abortion was never for a moment considered after the ultrasound revealed that the twins were conjoined. "I couldn't have an abortion," she said. "It was not in my mind. And if I was going to have the babies, they were going to be separated."
The couple said they have no idea how they will pay their hospital bills, which already exceed $30,000 without including intensive care expenses. Hopkins will try to qualify Ms. Varela for government assistance, a spokeswoman said.