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      Complete sternal cleft with tetralogy of Fallot

      case-report

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          Abstract

          Complete sternal cleft is a very rare congenital midline defect of the sternum. It is not uncommonly associated with intracardiac defects. We report a case of a 2-year-old child with complete sternal cleft and tetralogy of Fallot who presented with cyanotic spells. The child underwent total correction, followed by chest wall reconstruction on the next day.

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          Sternal cleft: a surgical opportunity.

          Rodolfo Majluf, Cássia Barbosa, Patrícia Garrido … (2003)
          The aim of this study was to evaluate the results from the surgical techniques utilized to repair congenital sternal cleft. From January, 1987 to January, 2001, 5,182 patients were seen for chest wall malformations. Eight (0.15%) had sternal cleft. The age at presentation ranged from 15 days to 5 years. Six were girls (75%). The associated malformations were congenital cardiac malformations (2 patients), maxillofacial hemangioma (1 patient). All of them underwent a surgical repair, which could be classified into 3 methods: group 1 had primary closure of the defect (3 patients); group 2 underwent partial resection of the first, second, and third costal cartilages, disruption of the sternoclavicular junction, and closure of the sternal bars with stainless steel wire (3 patients); and group 3 had mobilization and approximation of the sternocleidomastoid muscles with closure achieved with costal homograft and prosthetic mesh (2 patients). The interval for postoperative follow-up was 1 to 8 years. Group 1 patients developed well, although 2 of them had a slight degree of pectus excavatum in the long term not requiring surgical correction. Group 2 Patients developed without problems in all cases. One of the patients from group 3 had unsatisfactory aesthetic and functional results. He underwent reoperation with the second technique, achieving an improved result. Primary closure of the sternal cleft is the easiest technique. It should be performed in young infants. In the long term it can lead to a mild degree of pectus excavatum. The costal cartilage resection with mobilization of the clavicle achieved excellent results and allowed ready approximation of both sternal halves avoiding the use of costal grafts and prosthetic material. Copyright 2003, Elsevier Science (USA). All rights reserved.
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            Sternal malformation/vascular dysplasia association.

            S F O'Sheal, Susana Martinez-Conde, M J Harrod … (1985)
            Sternal defects associated with superficial craniofacial vascular lesions are rare. We report on two additional patients with a sternal cleft and cutaneous, craniofacial hemangiomata to emphasize that this unusual combination of findings represents a recognizable sternal malformation/vascular dysplasia association. In addition, internal vascular lesions were also identified in these individuals, in one instance involving the upper respiratory tract and in the other the viscera. Although the pathogenesis of these findings is unclear, an early disturbance affecting midline mesodermal structures leading to lack of complete fusion of lateral sternal bands and overlying cutaneous tissue, or deficient formation of a proposed medioventral unpaired structure which may be involved in the formation of the sternum, and persistence and proliferation of midline angioblastic tissue may be possible mechanisms during the sixth to ninth gestational weeks. To date, all but one of the 15 known cases have been sporadic and no teratogen has been identified as a cause for these clinical manifestations. The presence of this association should signal the need to search for potentially life-threatening internal hemangiomata.
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              Bifid sternum: neonatal surgical treatment.

              Marcello Dòmini, Massimo Cupaioli, Fabio Rossi … (2000)
              The sternal cleft is a rare congenital anomaly resulting from a fusion failure of the sternum, generally observed at birth and asymptomatic. Surgery is indicated to protect the heart and major vessels from trauma, to improve respiratory dynamics, and for aesthetic reasons. We observed 2 neonates for a superior and medial thoracic mass. The defect involved the upper two thirds of the sternum. The surgical operation for both patients consisted in the primary closure of the defect.
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                Author and article information

                Journal
                Journal ID (nlm-ta): Ann Pediatr Cardiol
                Journal ID (iso-abbrev): Ann Pediatr Cardiol
                Journal ID (publisher-id): APC
                Title: Annals of Pediatric Cardiology
                Publisher: Wolters Kluwer - Medknow (India )
                ISSN (Print): 0974-2069
                ISSN (Electronic): 0974-5149
                Publication date (Print): Jan-Mar 2020
                Publication date (Electronic): 04 December 2019
                Volume: 13
                Issue: 1
                Pages: 81-83
                Affiliations
                [1 ]Department of Cardiac Surgery, Narayana Superspeciality Hospital, Howrah, West Bengal, India
                [2 ]Department of Plastic Surgery, Narayana Superspeciality Hospital, Howrah, West Bengal, India
                [3 ]Department of Cardiac Anaesthesia, Narayana Superspeciality Hospital, Howrah, West Bengal, India
                [4 ]Department of Pediatric Cardiology, Narayana Superspeciality Hospital, Howrah, West Bengal, India
                Author notes
                Address for correspondence: Dr. Debasis Das, Department of Cardiac Surgery, Narayana Superspeciality Hospital, 120/1 Andul Road, Howrah - 711 103, West Bengal, India. E-mail: dasdeba@ 123456yahoo.com
                Article
                Publisher ID: APC-13-81
                DOI: 10.4103/apc.APC_86_19
                PMC ID: 6979026
                PubMed ID: 32030041
                SO-VID: 12f9c43e-5c3e-476e-8d05-199b69ad64ab
                Copyright © Copyright: © 2019 Annals of Pediatric Cardiology
                License:

                This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.

                History
                Date received : 12 June 2019
                Date revision received : 21 September 2019
                Date accepted : 08 October 2019
                Categories
                Subject: Case Report

                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: cleft sternum,surgical technique,tetralogy of fallot
                Data availability:
                ScienceOpen disciplines: Cardiovascular Medicine
                Keywords: cleft sternum, surgical technique, tetralogy of fallot

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