2018 AMI Online Salon

Cardiac Anatomy of 22-Month-Old Conjoined Twins with Complex Congenital Heart Disease

Project Details

  • Artist(s):  Natalie Koscal
  • Contributors: Natalie Koscal ; Boston, Massachusetts
  • Client: The New England Journal of Medicine
  • Copyright: © 2017 The New England Journal of Medicine
  • Medium / software used: Adobe Photohop and Adobe Illustrator
  • Final presentation format: Printed and online journal
  • Primary audience: Cardiologists, surgeons, and critical care specialists, especially those with pediatric specialization

Project Description

To convey the anomalous anatomy and blood circulation patterns in a challenging surgical case involving 22-month-old conjoined twins. Normal cardiac anatomy is also shown to facilitate comparison and to fully grasp the complexity and gravity of this unique case.

The twins were in critical condition, and both would likely die without separation surgery. However, intervention would save the life of Twin B at the expense of Twin A, making this case both technically and ethically challenging. The illustration helps the viewer to visualize what the team of surgeons were grappling with: due to Twin A’s aberrant physiology, Twin A was completely dependent on her sister’s circulatory support via blood shunted across a shared superior mesenteric artery. Though it was a difficult decision, the surgery was performed with the expected outcome, and Twin B is now doing quite well.