Abstract
BackgroundBy reviewing the outcomes of four patients, we summarize our experience with the strategy of using a titanium plate to reconstruct the inferior sternal cleft in pentalogy of Cantrell (POC).MethodsThis was a retrospective analysis of 4 patients who visited our department between January 2000 and June 2020 concurrent with POC. All four patients underwent an operation, as well as cardiac ultrasound and thoracoabdominal computed tomography (CT). Cardiac malformations achieved satisfactory correction according to echocardiographs. A titanium plate was used to repair the sternal and supraumbilical abdominal defects. The hospital course, operative data, and outpatient records were reviewed.ResultsAll 4 patients had partial sternal clefts, and 4 patients underwent a single-stage operation. All 4 cases of ectopia cordis were eventually repositioned. The defect in the sternum and supraumbilical abdomen was repaired using a titanium plate. One patient with double-outlet right ventricle (DORV) developed low cardiac output syndrome and pulmonary infection, and symptomatic treatment was administered until discharge. The mean follow-up time ranged from 9 months to 10 years. No patient developed pectus excavatum, and there were no cases of retrosternal seroma or pneumothorax. The titanium plate was migratory in the second patient and was dislodged at another hospital 3.5 years postoperation, and a fibreboard was formed in the area where sternal cleft; the beating heart could not be observed outside the thoracoabdominal or thoracic wall. In the first patient, the titanium plate was torn with a small fissure at 2 years postoperation, but the fissure was not enlarged during follow-up. In the other two patients, the appearance of both the abdominal wall and lower sternum and cardiac function were good. The New York Heart Association function class was I in all four patients.ConclusionThe use of a titanium plate to construct the neosternum can yield a satisfactory exterior appearance of the thorax with a partial sternal cleft, but long-term outcomes need to be examined further.
Technique Using a Titanium Plate to Reconstruct the Inferior Sternal Cleft in Pentalogy of Cantrell: Lessons From Four Patients
