Sternal Cleft and Pectus Excavatum: A Combined Approach for the Correction of a Complex Anterior Chest Wall Malformation in a Teenager (original) (raw)
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Complete congenital sternal cleft associated with pectus excavatum
Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital, 2002
We report herein a rare case of complete congenital sternal cleft (absent sternum) and anterior pericardial defect in association with pectus excavatum. In neonates with absent sternum, the sternal bars can be easily approximated by simple suture, due to the flexibility of the cartilaginous thorax. There is also little danger of cardiac compression when the repair is performed early in life. If reconstruction is delayed, the increased rigidity of the chest wall and the physiologic accommodation of the thoracic organs to the circumference of the chest render simple approximation impossible, without serious compromise of the heart and lungs. Our patient was a 13-year-old girl, whose case was particularly unusual because of the association of sternal cleft with pectus excavatum. After surgical correction of the pectus excavatum, we were able to construct a sternum by incising the lateral border of each sternal bar, thereby creating flaps that we sutured together at midline. The sternal...
Repair of congenital sternal cleft in infants and adolescents
Annals of Thoracic Surgery, 1998
Background. Clinical and surgical aspects of sternal cleft repair are presented. Primary repair in the neonatal period is the best management for this rare condition, but none of the patients in this report were referred to us during that period. Autologous repair is suitable for older patients because it avoids problems related to the implant of prosthetic materials.
Sternal cleft—a natural absurdity or a surgical opportunity
Journal of Pediatric Surgery, 2007
Sternal cleft is a rare visually dramatic congenital anomaly. It results from failure of fusion of the 2 lateral mesodermal sternal bars by the 8 weeks of gestation. Superior clefts are more frequent than inferior ones, and isolated central clefts are extremely rare. We describe the case of a 4-year-old girl with a central sternal cleft that was closed autogenously with pectoralis major advancement flaps.
Sternal cleft: A surgical opportunity
Journal of Pediatric Surgery, 2003
The aim of this study was to evaluate the results from the surgical techniques utilized to repair congenital sternal cleft.
Sternal cleft: Case report and review of a series of nine patients
American Journal of Medical Genetics, 1995
Cleft sternum is a rare malformation due to partial or total failure of sternal fusion at an early stage of embryonic development. Sternal clefts can be classified as superior, inferior, or complete. Here we report on a 2-year-old boy with inferior sternal cleft and complex cardiac malformation. We review a series of 9 children with sternal clefts, referred to us over a 10-year period. Hypothetical mechanisms for this developmental anomaly are discussed. 0 1995 Wiley-Liss, Inc.
European Journal of Cardio-Thoracic Surgery, 2012
Sternal cleft is a chest wall malformation that can expose mediastinal viscera and vessels to injuries. It can be classified into two forms, complete and partial. Its etiology and incidence are unknown and it is often associated with other defects. The aim of this article is to review the literature and report our experience with this rare anomaly, focusing on clinical presentation and management. We reviewed the English written literature about sternal cleft and collected the clinical data of all the published series. We present seven new cases that we have observed and treated since 1999. Literature reports 51 series including 86 patients, more frequently female (62%) and affected with partial superior form (67%). Sternal cleft is often asymptomatic (74%) and associated with other defects (72%). Surgical treatments include primary closure (73%), bone graft interposition (10%), prosthetic closure (7%), and muscle flap interposition (3%). In our series, primary closure was possible in four cases, while in three cases we placed a prosthesis. Five patients had associated defects and two were affected with PHACES (posterior fossa abnormalities, hemangiomas, arterial lesions, cardiac abnormalities/aortic coarctation, abnormalities of the eye, and sternum defects) syndrome. We report for the first time the association of sternal cleft with connectival nevi in three of our patients. At follow-up, we observed no major complication or recurrences. Although primary closure is the preferred option and should be performed in the neonatal period, the use of prostheses warrants good results as well. Prior to treatment, associated defects and syndromes should be excluded.
Chest wall anomalies: pectus excavatum and pectus carinatum
Adolescent Medicine Clinics, 2004
Adolesc Med 15 (2004) 455-471 omphalocele in the case of bifid sternum, all of which complicate the management of these patients (see Table 1). Surgical management has undergone major changes over the last 15 years. In the 1960s and 1970s, radical surgical operations were in vogue, even in very young children. It came to be realized, however, that pulmonary function actually decreased over time because of the scarring of the anterior chest wall, and some patients developed acquired asphyxiating chondrodystrophy from resections that were too extensive and performed at too early an age. As a result, surgeons stopped operating on prepubertal patients and reverted to modified resections of the deformed cartilages. Recently, a minimally invasive procedure with no resection, only internal bracing, has been introduced.
Respiratory Case Reports, 2016
It may occur with abdominal and/or thoracic malformations. Clinical features may vary depending on the associated disorders. Early repair may yield better results. Herein, we present a three-month-old girl with sternal cleft operated.