Heloisa and Helena, conjoined twins born connected at the head, died after undergoing a 15-hour operation, the final stage of a complex separation surgery, on Saturday, August 15.
The two girls were two years and seven months old. They had undergone four previous surgeries in preparation for the final procedure to completely separate them. More than 50 medical and support staff were involved in the operation, which was intended to allow the girls to begin rehabilitation independently.
Blood pressure changes during surgery
Tragically, a change in the twins' blood pressure occurred while they were on the operating table at the Hospital das Clinicas in Ribeirao Preto, southeastern Brazil.
The medical team said the twins experienced haemodynamic instability - low or erratic blood pressure meaning vital organs cannot get oxygen - and changes in blood pressure during the procedure. Haemodynamic instability, in severe cases, can lead to multiple organ failure.
Cardiac arrests and deaths
One of the twins developed low blood pressure, while the other suffered high blood pressure. According to the hospital, the girls were completely separated, but their condition deteriorated afterwards.
Helena suffered a cardiorespiratory arrest at 11.12pm and was resuscitated for 25 minutes before being pronounced dead at 11.37pm. While Helena was still being resuscitated, Heloisa suffered a cardiac arrest at 11.26pm. She was also resuscitated for 25 minutes but was pronounced dead at 11.51pm.
Fragile bodies and previous operations
One of the doctors coordinating the medical team, plastic surgeon Jayme Farina Junior, revealed the twins' bodies were particularly fragile. He said: "They had many bouts of pneumonia, they had a tracheostomy, they needed a gastrostomy for feeding, and they had episodes that also weakened their bodies. But at the moment of the final separation, their bodies could not withstand this instability. And then they progressed to cardiac arrest."
The girls had undergone four operations since August 2025, with the first completing around 25% of the planned separation and the third reaching around 75% separation of their shared brain tissue and blood vessels. The fourth surgery involved fitting tissue expanders to increase the amount of skin available to close their skulls after the final separation. This was the third time craniopagus twins were treated at the Hospital das Clinicas.
Burial and family response
Heloisa and Helena were buried a day after their deaths, in Sao Jos dos Campos, where their family lives. Their father, Amarildo Batista da Silva, said he did not see their deaths as a defeat for the medical team, saying: "Every child you lose is a defeat, every child you manage to save is a victory. I am sure you have far more victories than defeats, so this does not become a defeat."
