Our UF Health care teams made national headlines last fall when we hosted a news conference and announced the successful separation of 4-monthold conjoined twins, Savannah and Scarlett, who were born in April and separated in June.

In a crowded conference room at UF Health Shands Hospital, the regional news media — and thousands watching the event online in real-time — learned of the family’s incredible journey and the outstanding care provided by our faculty, nursing teams and staff. Conjoined twins are extremely rare, occurring about once in every 200,000 live births, and are only given a 5 to 25 percent chance of survival. Savannah and Scarlett were attached at the liver, diaphragm, sternum and heart and required multiple expert teams to mastermind their complex medical needs.

Following the babies’ successful delivery at UF Health Shands Children’s Hospital, Jennifer Co-Vu, M.D., FAAP, a UF College of Medicine pediatric cardiologist and UF Health Congenital Heart Center Fetal Cardiac Program director, her team and many other colleagues across UF Health used the first-known 3-D printed conjoined twin heart models to prepare for the complicated separation surgery.

During the procedure — which took more than six hours — the twins were separated by teams led by Mark Bleiweis, M.D., UF College of Medicine pediatric and congenital cardiovascular surgery chief and UF Health Congenital Heart Center director, and Saleem Islam, M.D., M.P.H., UF College of Medicine division of pediatric surgery chief.

The UF Health Shands Children’s Hospital Pediatric Cardiac ICU nursing team — led by nurse manager Joshua Campbell, B.S.N., R.N., CCRN — cared for Savannah and Scarlett after separation and for the weeks following.

Faculty physicians, nurses and staff from many other teams also provided valuable assistance. This groundbreaking surgery was possible thanks to “a village” of UF Health experts and colleagues working together in sync.

Savannah and Scarlett have since endured a few more procedures each, and after weeks of postoperative care, the twins’ parents, Jacquelyn and Mark, were finally able to take their babies home in the fall.

Turn to pages 6-7, where we highlight some of the amazing staff who cared for Savannah and Scarlett during their stay with us.

“While the simple headline could be ‘conjoined twins were separated’ — that’s not the story,” said Ed Jimenez, UF Health Shands CEO. “The headlines will never properly convey the hundreds of people and tremendous teams that came together to do something extraordinary here.”

The OB/GYN and maternal-fetal medicine team were among the first to interact with the family. Faculty and staff met with the twins’ parents, Jacquelyn and Mark, after they received a grim prognosis from another hospital. The team conducted numerous ultrasounds and preliminary tests to monitor the twins’ growth and progression, as well as Jacquelyn’s health. Alongside Labor and Delivery nursing staff, they participated in all aspects of delivery planning, helped schedule the twins’ birth, performed a successful C-section and helped the family prepare for the journey and care that followed.

Meanwhile, Jacquelyn and Mark were referred to a specialist at the Fetal Cardiac Program, an extension of the UF Health Congenital Heart Center. This team determined the twins had a connection at the level of the heart, and sonographers were instrumental in delineating the babies’ intricate cardiac anatomy. They also monitored the complex cardiovascular physiological changes as they occurred prior to birth. The team led the planning for the multidisciplinary care that was needed for the twins prior to delivery. The team also assisted in the coordination of the babies’ delivery and separation.

The NICU team was instrumental in the planning process prior to the twins’ delivery. NICU faculty, nurses and staff were present at the birth to assess and resuscitate Savannah and Scarlett if needed. Pharmacy staff with neonatal expertise also played an important role collaborating with the clinical team and answering the family’s questions regarding medications and dosing for the twins. Leading up to the separation surgery, the NICU team provided primary neonatal management, including assessing respiratory and nutritional needs, discussing cardiovascular needs with the cardiology team and making progress toward the goals set for separation.

Scarlett and Savannah required two anesthesiology teams for procedures during their stay here. They were sedated for the surgery and for two preoperative MRIs: one that provided imaging to build the 3-D heart, and another that helped the surgical team plan the separation. The anesthesiologists were challenged by the newborns’ shared circulatory system and the way the babies were positioned. There was no precedent for a sedation of this kind, so simulation prior to surgery was key, and collaboration with numerous subspecialists was essential.

After the twins were born, cardiac imaging specialists performed noninvasive imaging procedures — including cardiac echocardiograms, CTs and MRIs — to delineate the infants’ cardiac anatomy. Prior to birth, the team had limited angles with which to examine the babies, requiring the 3-D model. After birth, physicians could fully analyze their cardiac anatomy. The cardiac CT was used to create the 3-D model, while the cardiac MRI helped delineate the connections while the heart is in motion. The Cardiac Catheterization team was instrumental in performing an urgent balloon atrial septostomy on Scarlett minutes after she was separated from Savannah. Scarlett was rushed to the Cardiac Catheterization Laboratory, where a balloon catheter was placed in the wall separating the two upper chambers of Scarlett’s heart, enabling the necessary mixing of the blood for a patient with transposition of the great arteries.

After birth, the twins also underwent regular X-rays, CTs and MRIs to help our care teams better understand the anatomy of their other organs, including their livers and bowels. These studies helped create the models of the liver used by surgeons for separation planning. Just before surgery, the radiology team — including physicians and technologists — helped to delineate all major blood vessels on the ultrasound. Following the separation, the babies continued to need X-rays to check their lungs, hearts and
bowels regularly.

The Pediatric Congenital Cardiovascular Surgery and the Pediatric Surgery teams — including surgeons, nurses and technicians — collaborated for a six-plus-hour surgery to successfully separate the twins, which involved separating their hearts and livers. Between the separation surgery and other procedures, the twins underwent more than a dozen procedures each.

In the Pediatric Cardiac ICU, or PCICU, Savannah and Scarlett benefited from an interdisciplinary team of attending physicians, nurses, nurse practitioners and physician assistants who provide care for patients in the UF Health Congenital Heart Center. After surgery, the girls were placed in separate rooms in the PCICU and monitored
around the clock. Once the twins were stabilized and given recovery time, they met for the first time separated and side-by-side.