A heteropagus conjoined twin is not viable because it is a partially formed parasitic monozygotic twin, asymmetrically attached, and completely dependent for survival on the viable and dominant twin, termed as the autosite. A conjoined twin joined dorsally along the vertebral column is known as a "parasitic rachipagus," from the Greek words "rachi" (spine) and "pagus" (fixed), and is the rarest type (2).
Parasitic Twin Presenting Rudimentary Upper Limbs Causes A Unique Spectrum of Anomalies of Autosite. Balkan Med J 2018;35:445-6
Heteropagus conjoined twins (also known as parasitic twins) are defined as the presence of a nonviable and severely impaired fetus (or fetal parts) attached to a relatively normal twin (termed the autosite) in one of the same areas in which intact conjoined twins would be united .
The autosite was a completely developed girl with an intact omphalocele containing parts of the liver.
3D CT and MRI (Figure 2) showed that the autosite had a fallot tetralogy and a double aortic arch with its ventral branch splitting into a large vessel: one leading to the parasite (forming the equivalent of an aorta there) and the second vessel inserted into the omphalocele forming the superior mesenteric artery.
The large vessel from the autosite branched into the iliac arteries.
Initially, the shoulder girdle of the parasite was separated from the thorax of the autosite. The large arteria originating from the ventral branch of the doubled aorta inserting into the parasite was excavated and sealed with a clip.
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The partially developed twin is known as parasitic as it depends on the dominant twin or autosite
twin to survive.
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