- The Washington Times - Sunday, February 8, 2004

SANTO DOMINGO, Dominican Republic — A 7-week-old Dominican girl born with one of the world’s rarest birth defects died yesterday, hours after undergoing a delicate operation to remove an undeveloped second head.

Rebeca Martinez died of post-surgical bleeding and a heart attack around 6 a.m., said Dr. Santiago Hazim, medical director of the CURE International Center for Orthopedic Specialties in Santo Domingo.

An international team of doctors operated on Rebeca for some 12 hours Friday to remove the second head in what was thought to be the first such operation ever.

The child’s parents, Maria Gisela Hiciano and Franklin Martinez, called their daughter’s death the will of God and praised the 18 doctors who carried out the surgery.

“God must have wanted it this way. He must have his reasons,” Mrs. Hiciano, 26, said at a news conference yesterday with Dr. Hazim.

“If there is one grade above super-excellent, it belongs to this team of doctors,” Mr. Martinez, 29, said.

Mr. Martinez and his wife appeared calm and resigned, the father describing them as a Christian couple “believing always in Jesus Christ.”

They had been aware that the surgery would carry risks, Mr. Martinez said.

“We hoped we would have Rebeca alive today, but God did not want this to be so, and we respect His will,” he said.

The surgery in the capital of the Caribbean nation was led by Dr. Jorge Lazareff, director of pediatric neurosurgery at UCLA’s Mattel Children’s Hospital, and two Dominican surgeons, Dr. Hazim and Dr. Benjamin Rivera.

Dr. Lazareff last year led the surgical team that successfully separated Guatemalan twin girls who were joined at the head.

Rebeca’s doctors had announced the operation was successfully completed late Friday, but cautioned that she would face many risks as she recovered, such as infection or hemorrhaging.

Rebeca had several blood transfusions, which complicated normal clotting, doctors said yesterday. They said her heart was accustomed to beating faster to pump out more blood for the second head.

“At some point in the middle of the night, she started to bleed,” Dr. Lazareff said.

“In that case, you can’t do anything,” Dr. Rivera said. “This is the worst complication that can happen in this kind of surgery.”

Rebeca was born in mid-December at a hospital in Santo Domingo with the head of an undeveloped twin attached to the top of her skull, facing upward. The infant was otherwise healthy, but her brain could not develop normally unless the undeveloped head was removed.

The $100,000 operation was offered free to the parents, a supermarket cashier and a tailor who together make about $200 a month.

The girl’s condition, cranio pagus parasiticus, is so rare that only eight documented cases are known in the world. There are no known previous cases where surgery was attempted to correct the birth defect, Dr. Hazim said before the surgery.

Conjoined twins form when an embryo begins to split into identical twins and then stops, leaving them fused.

Rarer “parasitic” twins occur when one conjoined twin stops developing in the womb, leaving a smaller, incomplete twin that is dependent on the other. The second twin can form as an extra limb, torso or head, or as a complete second body, lacking vital organs.

In Rebeca’s case, there was a gap in her skull where the heads were joined, and the blood vessels were intertwined. The vestigial head was enlarged and fringed with dark hair like Rebeca’s but had a poorly developed brain and only rudimentary facial features.

“We always saw Rebeca without the extra part of her body,” Mr. Martinez said, adding: “We want to bury Rebeca as soon as possible so she can rest.”

Rebeca was her mother’s third child, after a 4-year-old boy and a 1-year-old girl.

“We aren’t going to have any more children,” Mrs. Hiciano said. “Not because of what happened to Rebeca, but for economic reasons.”

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