case_images: PMC11634310_01
case_images: Gemeas unidas fundidas ventralmente pelo torax, apresentando abdome com assimetria dos membros inferiores.
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case_images: We report the case of premature conjoined female twins (34 weeks and 3 days), joined ventrally by the thorax, abdomen, and pelvis, with heteropagus characteristics (asymmetry: 3 lower limbs: tripus), sharing the same pericardium (separate hearts), liver, and bladder, also under investigation into the fusion of other abdominal structures (Figure 1) and with evidence of congenital heart disease in the second twin.
case_images: Ecocardiograma complementar e angiotomografia. A) Ecocardiograma mostrando 2 coracoes compartilhando o mesmo pericardio. B) Corte ecocardiografico identificando as seguintes estruturas: aorta descendente, arteria pulmonar esquerda e persistencia do canal arterial e suas medidas, onde 1 = ampola pulmonar, 2 = ampola aortica e 3 = comprimento. C) Tomografia com reconstrucao ossea individualizando as gemeas. D) * Coracao da segunda gemea. E) ** Persistencia do canal arterial.
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case_images: Patent ductus arteriosus with hemodynamic repercussions was demonstrated by echocardiogram (Figure 2A) and computed tomography angiography (Figure 2C, 2D, 2E).
case_images: Passo a passo da intervencao percutanea. A) Angiografia no introdutor venoso mostrando a veia cava inferior drenando para o coracao da segunda gemea. B, C, D) Fluoroscopia mostrando o canal arterial cruzado com guia e cateter passando pelo atrio direito, ventriculo direito, tronco pulmonar na aorta descendente de forma anterograda, e aorta e sendo posicionado na aorta descendente. E) Angiografia do canal arterial. F) Fluoroscopia mostrando o avanco da bainha do tronco pulmonar para a aorta descendente. G) Dispositivo Piccolo  e suas marcas radiopacas sendo posicionadas. O termometro esofagico e geralmente um marco radiopaco para delimitar a ampola aortica e a canula orotraqueal e geralmente um marco radiopaco para delimitar a ampola pulmonar. AD: atrio direito; Ao: aorta; Ao Desc: aorta descendente; TP: tronco pulmonar; VD: ventriculo direito.
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case_images: Angiography was performed on the venous introducer to confirm the venous drainage of the inferior vena cava in the second twin's heart (Figure 3A). A Judkins right 4F cordis catheter was used on a 0.014" 190 cm Balance Heavyweight guidewire to perform angiography in the crossed ductus arteriosus in an anterograde manner (Figure 3B), confirming the diagnosis of patent ductus arteriosus. (Figure 3C). TorqVue 4F sheath, advanced through the ductus arteriosus (Figure 3D) to the descending aorta for device implantation, based on sequential echocardiographic and angiographic measurements (Figure 4A).
case_images: Correlacao angiografica (A) e ecocardiografica (B) mostrando as medidas do canal arterial, sendo * ampola pulmonar, ** ampola aortica e *** comprimento do canal arterial, fundamental para escolha do dispositivo. C) Dispositivo Piccolo . D e E) Dispositivo liberado mostrando bom posicionamento final, sem shunt residual. Ao: aorta; Ao desc: aorta descendente; APE: arteria pulmonar esquerda; PCA: persistencia do canal arterial; TP: tronco pulmonar.
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case_images: PMC11634310_01_0066-782X-abc-121-12-e20240351-gf04.jpg
case_images: f4
case_images: TorqVue 4F sheath, advanced through the ductus arteriosus (Figure 3D) to the descending aorta for device implantation, based on sequential echocardiographic and angiographic measurements (Figure 4A). The Piccolo  (Abbot Structural Heart, Plymouth, MN, USA) 4.0 x 4.0 mm was chosen (Figure 4B). The catheter and introducer were removed, and compressive occlusive dressing was applied after manual hemostatic compression.