Virginia Commonwealth University

Forever joined at the heart

When the nurse presented Lisandra Sanatis with her twins, Maria and Teresa Tapia, on April 8, 2010, and explained to her that the girls were conjoined and might not make it, Sanatis said she put her faith in God. When news of the twins spread throughout her country, prompting a visit from the Dominican Republic’s first lady, Sanatis put her faith in that woman’s promise that everything would be all right. And, when it came time to surgically separate the girls, Sanatis put her faith in the Children’s Hospital of Richmond at VCU.

Nearly two years after that fateful day in April, Sanatis’ faith paid off in the form of two separate, healthy and vibrant girls ready to experience the world on their own, even as the emotional connection forged during the time they spent dependent on each other continues to grow.

As doctors in the Dominican Republic recognized they would be unable to provide the quality of care necessary for Maria and Teresa’s condition, they reached out to the World Pediatric Project (WPP) — an organization that works to bring pediatric surgical, diagnostic and preventive resources to critically ill children in developing countries. WPP, in turn, reached out to a team led by David Lanning, M.D., Ph.D., associate professor in the Department of Surgery and CHoR’s surgeon-in-chief, who had worked with the organization in the past.

Lanning and his team soon discovered that Maria and Teresa, joined at the lower chest and abdomen, shared a liver, as well as parts of their biliary system, pancreas glands and the first part of their small intestine, which prevented Maria from receiving the nutritional benefits she needed and caused her to be about 20 percent smaller in size than her sister. Additionally, the lack of blood return to Maria because of their shared liver presented a major challenge to the surgery.

However, the upside was that the girls were otherwise separate, with normally functioning organs throughout the majority of their bodies, including their lungs, hearts, urinary systems and extremities. Armed with this knowledge, Sanatis made the decision to go ahead with the separation, sparking a journey that would require the volunteer efforts of more than 45 physicians and pediatric specialists.

But, what started as a medical case quickly turned into a community rally that extended far beyond the hospital walls.

Kristin Caskey, associate professor and interim assistant chair of VCU’s Department of Fashion Design and Merchandising, worked with a group of students to design custom dresses for the twins to wear while they awaited their surgery. Morgan Yacoe, a senior in VCU’s Department of Sculpture, spearheaded an effort to create a plaster casting mold of the twins’ bodies to assist surgeons’ preparation for the surgery and cosmetic care required after separation. And, with so many trips between hotel and hospital (as well as some fun community outings) to be considered, Audrey Kane, an occupational therapist at VCU and a certified car-seat technician, designed a special car seat large enough to comfortably accommodate both Maria and Teresa.

All the while, Lanning and his team mapped out a detailed treatment plan, which included comprehensive diagnostics of the twins’ anatomies, the insertion of tissue expanders to enable the growth of excess skin to be used for reconstructive surgery following the separation, and a step-by-step operative time table and list of procedural protocols.

At 6 a.m. Monday, Nov. 7, 2011, Lanning and his team put their plan in motion, embarking on a 20-hour series of procedures to divide the twins’ liver and other shared organs before reconstructing their abdominal walls. A month later, doctors released the girls to the Hospital Hospitality House and, following their initial rounds of occupational and physical therapy, Maria and Teresa returned home to the Dominican Republic in December.

“My experience at Children's Hospital of Richmond at VCU was a beautiful experience, particularly the medical team, the nurses who have been so gracious and made me feel like family,” Sanatis said. “I am very much looking forward to going back home and bringing my girls back to see their brothers and spending time with my children.”