Bessy and Doris Gonzales briefly went back into surgery Thursday morning, in a continuing medical crisis. The unscheduled operation, to remove blood clots, was completed in about an hour.
On Wednesday, the day after their second operation to separate them, Bessy began bleeding inside her brain and Doris momentarily lost her pulse.Howard Noel, spokesman for Primary Children's Medical Center, said the twins remained in critical condition after surgery Thursday morning. Earlier, doctors had planned their next operation for no sooner than two weeks in the future.
The crisis struck on Wednesday, after the second operation to separate the 5-month-old girls, who are joined at the tops of their heads. Apparently all went well with Tuesday's operation to sever some shared blood vessels and brain tissue. But the next morning a potentially fatal complication developed.
"Bessy had a seizure," said their neurosurgeon, Dr. Marion Walker.
Immediately the children were given a brain scan, which showed Bessy was bleeding inside her brain. At one time, her systolic blood pressure was 240.
For many, a systolic reading of 140 or above indicates hypertension, high blood pressure.
"Doris tends to be on the hypotensive (low blood pressure) side, and when we treat Bessy's hypertension, Doris falls even further," Walker said.
When worried doctors tried to lower Bessy's blood pressure with medication, Doris "responded in a dramatic fashion." For a few seconds she was unresponsive. She had no blood pressure for a moment but then quickly her pulse resumed.
"They have stabilized early this morning," Walker told a press conference at the hospital Wednesday afternoon. The girls were moving, seeming to be about to wake up, he said.
If they were separated and he had been able to treat only Bessy's blood pressure and bleeding, "I wouldn't be really concerned about her not being above to survive," he said. But the constraints of not being able to treat one without affecting the other make the medical situation delicate and dangerous.
Walker said the extensive bleeding will cause brain damage for Bessy. "We have drained it (the blood) with a catheter . . . The bleeding has stopped," he added.
Bessy was in much worse condition than her sister. Her blood pressure remained high.
The strange conditions, with one girl having high blood pressure and the other low, has been true since birth. The operation triggered the bleeding, even though it did not reach the part of the brain where the bleeding took place, according to Walker.
Doctors were aware of the risk of bleeding but considered it relatively low.
Tuesday's operation meant that the twins are halfway separated. Walker had to cut through a small amount of shared brain tissue, probably not enough to cause serious damage.
The girls were stable on Wednesday afternoon. "Through the day she (Bessy) has been getting better instead of worse," Walker said. By Saturday afternoon, they should be out of immediate danger.