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      Agénésie sternale subtotale avec ectopia cordis: gestion chirurgicale et résultat à long terme (à propos d´un cas au Bénin) Translated title: Subtotal sternal agenesis with ectopia cordis: surgical management and long-term outcome (a case in Benin)

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          Abstract

          L´agénésie sternale comme l´ectopia cordis sont des malformations congénitales extrêmement rares. Nous rapportons l´unique cas pris en charge dans un service de chirurgie pédiatrique au Bénin. Il s´agissait d´une fillette de 3 ans ayant présenté depuis sa naissance une agénésie sternale avec ectopia cordis. Elle avait bénéficié initialement d´une cicatrisation dirigée puis secondairement d´une thoracoplastie avec succès. Les résultats à long terme sont bons. Elle est aujourd´hui âgée de 13 ans, scolarisée et présente un état clinique satisfaisant. Il s´agit d´un des rares cas rapportés dans la littérature et maintenu en vie par une gestion thérapeutique optimale dans un contexte ouest africain.

          Translated abstract

          Sternal agenesis as well as ectopia cordis are extremely rare congenital malformations. We here report a single case treated in the Department of Paediatric Surgery in Benin. The study involved a 3-year-old girl with congenital sternal agenesis associated with ectopia cordis; firstly, she underwent controlled healing. Then thoracoplasty was performed with favourable outcome. Long-term results are good. Now, she is 13 years old, is attending school and has a satisfactory clinical condition. This is one of the few cases reported in the literature. Optimal therapeutic management has been keeping the patient alive in West Africa.

          Most cited references10

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          Etiology of chest wall deformities--a genetic review for the treating physician.

          Chest wall deformities such as pectus excavatum, pectus carinatum, and cleft sternum can be isolated malformations or dysmorphic features of genetic associations, monogenic disorders, and various numeric and structural chromosomal aberrations. In contrast to the most important syndromes such as Marfan syndrome or Noonan syndrome that can be associated with a chest wall deformity and for which the causative genes are known, etiology of isolated chest wall deformities is still a matter of research. Therefore, an interdisciplinary approach, particularly in patients with additional symptoms is strongly recommended to choose the best therapeutic approach for each patient and its family.
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            Twenty seven-year experience with sternal cleft repair.

            Congenital sternal cleft is a rare disease, and primary repair in the neonatal period is its best management. In 1998 we presented three surgical techniques for sternal cleft correction, but since 1999 we have elected one of them as our procedure of choice. Our latest results are now presented. It is a review of 15 patients operated from October 1979 to December 2007. Surgical repair consisted of 3 sliding chondrotomies, 10 reconstructions based on a 'posterior sternal wall', 1 reconstruction combined to Ravitch operation for pectus excavatum and 1 associated with total repair of Cantrell's pentalogy. Data concerning epidemiological features, surgical reconstruction, aesthetic results, postoperative major complications, mortality and hospital stay, were collected from hospital charts. Follow-up ranged from 4 months to 27 years. All patients submitted to surgical correction had a good aesthetic and functional result. Neither postoperative mortality nor major complication was observed. Two patients had subcutaneous fluid collection that prolonged the drainage duration. The mean hospital stay was 6 days. In conclusion, reconstructing sternal cleft with a 'posterior periosteal flap from sternal bars and chondral graft' is an effective option with good aesthetic and long-term functional results.
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              Cantrell Syndrome—A Rare Complex Congenital Anomaly: A Case Report and Literature Review

              Cantrell syndrome (CS) or pentalogy of Cantrell is defined as a rare condition involving a midline anterior abdominal wall defect, a distal sternal cleft, a defect of the anterior diaphragm, and a defect of the apical pericardium with pericardio-peritoneal communication, as well as intracardiac anomalies. We report the case of a male newborn with type 2 CS diagnosed during intrauterine life based on ultrasonographic evaluation. Clinical examination at birth revealed an abdominal wall defect with extrathoracic displacement of the heart and a diastasis of the sagittal suture. Postnatal echocardiography revealed tricuspid atresia, partial extrathoracic and extra-abdominal displacement of the heart and liver, a large ventricular septal defect, severe subpulmonary stenosis, hypoplasia of the pulmonary artery, and a large hourglass-shaped left ventricle secondary to narrowing of the heart at the level of its extrathoracic displacement. Computed tomography showed additional abnormalities including increased left ventricular volume with extrathoracic apical aneurysmal dilatation below the xiphoid process at the level of anterior abdominal wall, a hypoplastic right ventricle, partial transparietal herniation of the left hepatic lobe adjacent to a left ventricular diverticulum, and an adrenal hematoma. The newborn received intensive medical management during his first week of life; however, surgical management had to be postponed owing to his unstable condition. Eventually, it was performed on the 14th day of life, but unfortunately, the newborn died shortly after the procedure.

                Author and article information

                Journal
                Pan Afr Med J
                Pan Afr Med J
                PAMJ
                The Pan African Medical Journal
                The African Field Epidemiology Network
                1937-8688
                11 August 2021
                2021
                : 39
                : 233
                Affiliations
                [1 ]Service de Chirurgie Pédiatrique du Centre Hospitalier Universitaire de la Mère et de l´Enfant-Lagune, 01 BP 107, Ave Delorme, Cotonou, Bénin,
                [2 ]Service d'Anesthésie-Réanimation du Centre Hospitalier Universitaire de la Mère et de l´Enfant-Lagune, 01 BP 107, Ave Delorme, Cotonou, Bénin,
                [3 ]Clinique Universitaire de Chirurgie Pédiatrique du Centre National Hospitalier Universitaire Hubert Koutoukou Maga, 06 BP 386, Cotonou, Bénin,
                [4 ]Département de Chirurgie Pédiatrique de l´Hôpital Mère-Enfant de Las Palmas de Gran Canaria, Unité de Coopération Internationale des Iles Canaries c/ Gran Canaria 7-4°C, 35008 Las Palmas de Gran Canaria, Espagne
                Author notes
                Corresponding author: Abdel-Kémal Bori Bata, Service de Chirurgie Pédiatrique du Centre Hospitalier Universitaire de la Mère et de l´Enfant-Lagune, 01 BP 107, Ave Delorme, Cotonou, Bénin.bbak@ 123456live.fr
                Article
                PAMJ-39-233
                10.11604/pamj.2021.39.233.25646
                8498673
                7f178fdc-1523-4fc1-b1ab-0da7a7cfd27d
                Copyright: Antoine Séraphin Gbenou et al.

                The Pan African Medical Journal (ISSN: 1937-8688). This is an Open Access article distributed under the terms of the Creative Commons Attribution International 4.0 License ( https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 18 August 2020
                : 07 April 2021
                Categories
                Case Report

                Medicine
                agénésie sternale,ectopia cordis,thoracoplastie,à propos d´un cas,sternal agenesis,thoracoplasty,case report

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