Primary Closure of a Subtotal Sternal Cleft in a 7-Day-Old Neonate

Sternal cleft is a rare congenital abnormality that results from incomplete fusion of the two lateral mesodermal sternal bars. It is generally accepted that primary repair in the neonatal period is the best treatment option. However, significant distance between the sternal bars can be challenging because of cardiac compression. The aim. We report a case of a 7-day-old neonate with a subtotal sternal cleft successfully managed by direct closure. Material and methods. A full-term male neonate weighing 3 kg was referred to our clinic for evaluation of a chest wall defect. The chest X-ray and computed tomography were performed to evaluate the malformation. Results. Surgery was performed at the age of 7 days. Postoperative period was uneventful. The patient was discharged on the postoperative day 21. The first postoperative checkup after 3 months showed satisfactory cosmetic results and normal respiratory movements. Conclusion. Despite the significant diastasis between sternal bars, primary direct closure of the sternal cleft can be safely performed in neonates.

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Primary closure of superior partial sternal cleft in a 2-month-old girl: case report

Annals of Pediatric Surgery ◽

10.1186/s43159-021-00113-8 ◽

2021 ◽

Vol 17 (1) ◽

Author(s):

Halil Ibrahim Tanriverdi ◽

Fulya Doğaneroğlu ◽

Abdülkadir Genç ◽

Ömer Yılmaz

Keyword(s):

Case Report ◽

Primary Repair ◽

Three Dimensional ◽

Early Period ◽

Ventilator Support ◽

Case Presentation ◽

Sternal Cleft ◽

Cardiac Compression ◽

Rare Malformation ◽

Respiratory Movements

Abstract Background Sternal cleft is a quite rare malformation. It is seen 1 out of 100,000 live births and makes up less than 1% of all chest wall deformities, seen more often among females. The deformity can be partial or complete. Partial deformities can be superior or inferior. It is generally diagnosed at birth when paradoxical respiratory movements are seen. Patients are often asymptomatic when they are born and generally other abnormalities accompany. As sternal clefts can be repaired primarily at early ages, they are repaired using autologous or synthetic grafts in the following years. We present a 2-month-old girl with superior partial sternal cleft repaired primary and accompanying hemangiomas in this case report. Case presentation A girl who was born in another center and had a sternal cleft, who did not have any problems in the early period, was admitted to our hospital with respiratory distress at the age of 43 days. The patient was monitored with mechanical ventilator support, and there were hemangiomas around his left ear and lips. There were paradoxical respiratory movements in front of the heart, in the upper midline of the chest. Three-dimensional computed tomography showed that the upper part of the sternum did not develop, and there were hypoplasic sternal bars on both sides. It was evaluated as superior partial sternal cleft, and surgery was planned. In the operation, the sternal bars were released from the pericardium and pleura. The periosteum in the medial of both sternal bars was then released and connected in the midline, in front of the pericardium. Conclusion Although neonates with a sternal cleft are asymptomatic at birth, respiratory symptoms may develop in later periods. In addition, because the structures are more flexible in the neonatal period, the primary repair of the cleft is easier and the risk of cardiac compression is lower. In our case, sternal bars could be approached primary, and no chondral grafts, patches, or steel wires were required.

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Primary repair of sternal cleft with a double osteochondroplasty flap

Interactive Cardiovascular and Thoracic Surgery ◽

10.1093/icvts/ivt380 ◽

2013 ◽

Vol 17 (6) ◽

pp. 1036-1037 ◽

Cited By ~ 5

Author(s):

Quentin Ballouhey ◽

Mateo Armendariz ◽

Virginie Vacquerie ◽

Pierre Sylvain Marcheix ◽

Daniel Berenguer ◽

...

Keyword(s):

Primary Repair ◽

Sternal Cleft

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Synthetic mesh placement - modality of choice in spontaneous intercostal pleural herniation: a case report

International Surgery Journal ◽

10.18203/2349-2902.isj20215166 ◽

2021 ◽

Vol 9 (1) ◽

pp. 242

Author(s):

Shashwat Vyas ◽

Amit Goyal

Keyword(s):

Primary Repair ◽

Synthetic Mesh ◽

Weight Lifting ◽

Intercostal Space ◽

Mesh Placement ◽

Synthetic Materials ◽

Lung Hernia ◽

Chest X Ray ◽

Monofilament Mesh ◽

Spontaneous Herniation

Hernia is defined as protrusion of a viscus or its part from the wall covering it and in some rare cases due to increased intercostal space there is spontaneous herniation of pleura and lung also known as extrathoracic lung hernia. A 48 year gentleman was admitted in our centre for chest wall swelling which has developed spontaneously 1 year back, painless, with cough impulse, further investigations like chest x-ray revealed nothing , subsequently CT thorax showed intercostal pleural hernia. He underwent surgery which diagnosed it as a case of intercostal pleural hernia having defect between 8th and 9th rib. Subsequently primary repair of defect was done with placement of monofilament mesh over it and then approximation of intercostal space was done with monofilament suture placed over 8th and 9th ribs. Post operatively patient had no complications and no recurrence of hernia. Spontaneous pleural herniation is a usually caused by coughing, heavy weight lifting, weakness of thoracic muscles by smoking, obesity etc. Ideal management is to treat the aetiology along with repair of the defect to prevent recurrence. In the present case the hernia developed after a bout of cough due to increased intercostal space between 8th and 9th ribs and also due to obesity leading to weak musculature. Intercostal pleural hernia repair can be achieved by primary repair of defect but it is advisable to use synthetic materials such as knitted monofilament polypropylene (Marlex) mesh to provide addition support to prevent recurrence.

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First Sternal Cleft Repair Using a Porous Alumina Ceramic Prosthesis in a 9-Year-Old Child

European Journal of Pediatric Surgery Reports ◽

10.1055/s-0039-1688775 ◽

2019 ◽

Vol 07 (01) ◽

pp. e20-e23

Author(s):

Virginie Fouilloux ◽

François Bertin ◽

Emilie Peltier ◽

Jean-Luc Jouve

Keyword(s):

Porous Alumina ◽

Muscle Flap ◽

Alumina Ceramic ◽

Congenital Defects ◽

Deep Sternal Wound Infection ◽

Sternal Cleft ◽

Good Healing ◽

Rare Congenital Abnormality ◽

Sternal Reconstruction

AbstractSternal cleft is a rare congenital abnormality, often associated with other congenital defects. We present the case of a 9-year-old child with complete sternal cleft, treated with an innovative sternal prosthesis. Surgery was performed to protect the heart and also, as pulsations was visible, leading to serious esthetical concerns, to enhance school integration, which was difficult. The porous alumina device used was initially designed for sternal reconstruction after refractory deep sternal wound infection or carcinoma. Surgery and early follow-up were simple. There was no complication and the follow-up of more than 1 year reveals a good healing without breath discomfort and a correct development of the chest wall. In this rare indication, the alumina ceramic sternal prosthesis offers a reliable alternative to classical methods, such as muscle flap, autogenous tissue transfer, costal homograft, and other prosthetic materials like mesh or synthetic patch.

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Outcomes following Boerhaave’ syndrome

Annals of The Royal College of Surgeons of England ◽

10.1308/rcsann.2013.95.8.557 ◽

2013 ◽

Vol 95 (8) ◽

pp. 557-560 ◽

Cited By ~ 2

Author(s):

CL Connelly ◽

PJ Lamb ◽

S Paterson-Brown

Keyword(s):

Hospital Stay ◽

Primary Repair ◽

Length Of Hospital Stay ◽

Good Survival ◽

Boerhaave’S Syndrome ◽

Direct Closure ◽

Tube Drainage ◽

T Tube ◽

Boerhaave's Syndrome ◽

The Mean

Introduction Boerhaave’s syndrome is associated with high mortality and morbidity. This study aimed to assess outcome following treatment in a specialist upper gastrointestinal surgical unit. Methods Patients were identified from a prospectively collected database (Lothian Surgical Audit) and their records reviewed. Primary outcomes were mortality and serious morbidity. Secondary outcomes included time to theatre, operation undertaken and length of hospital stay. Results Twenty patients with Boerhaave’s syndrome were identified between 1997 and 2011. Four patients (20%) died in hospital. The mean time to theatre from symptom onset was 2.4 days. This was 7.3 days in the patients who died compared with 1.5 days in survivors. Five patients underwent primary repair of rupture, eleven underwent direct closure over a T-tube and one rupture was irreparable. Three patients were managed non-operatively and all survived. Outcomes were similar for the different surgical groups. There was one death following primary closure (20%) and two after T-tube drainage (18%). The mean length of hospital stay was 35.7 days after T-tube drainage and 20.5 days after primary repair. The 3 patients with small, self-contained leaks had a mean length of stay of 5.7 days. Conclusions Aggressive surgical management with direct repair is associated with good survival in patients with Boerhaave’s syndrome. Delayed time to theatre is associated with increased mortality. Patients with small, contained leaks without signs of sepsis can be managed non-operatively with a good outcome.

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Primary repair of complete sternal cleft associated with absent anterior pericardium

Journal of Cardiac Surgery ◽

10.1111/jocs.13132 ◽

2017 ◽

Vol 32 (5) ◽

pp. 316-317

Author(s):

Amr A. Arafat ◽

Ayman A. Sallam ◽

Amr A. Abdelwahab ◽

Abdel-Hady M. Taha

Keyword(s):

Primary Repair ◽

Sternal Cleft

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LEFT SUBCLAVIAN ARTERY RUPTURE DUE TO BLUNT THORACIC TRAUMA: A CASE REPORT

Jurnal Kedokteran Syiah Kuala ◽

10.24815/jks.v17i2.8989 ◽

2017 ◽

Vol 17 (2) ◽

pp. 103-111

Author(s):

Yopie Afriandi Habibie ◽

Ign Wuryantoro

Keyword(s):

Subclavian Artery ◽

Thoracic Trauma ◽

Left Subclavian Artery ◽

Primary Repair ◽

Median Sternotomy ◽

Traumatic Rupture ◽

Blunt Thoracic Trauma ◽

X Ray ◽

Massive Hemothorax ◽

Chest X Ray

Abstrak. Trauma tumpul toraks memiliki insiden yang sangat tinggi pada populasi dewasa, 20 – 50 % dari kasus dapat mengakibatkan kematian. Cedera pada struktur pembuluh darah dari bagian dada atas, terutama pembuluh darah arteri subklavia kiri, sangat jarang ditemukan dan biasanya disertai dengan “hematotoraks massif”. Observasi ketat dari tanda- tanda vital dan foto toraks serial sangatlah penting. Kami paparkan sebuah kasus jarang dari seorang pasien yang mengalami cedera traumatik arteri subklavia kiri. Tidak ditemukan gambaran klinis dari hematoma di supra klavikula, pulsasi arteri radialis kiri tidak teraba, dan tidak ditemukan pelebaran dari mediastinum pada foto toraks. Tetapi didapatkan hematotoraks massif kiri. Dilakukan posterolateral torakotomi kiri, dijumpai sumber perdarahan dari bagian apex paru kiri, dicurigai terdapatnya robekan dari pembuluh darah arteri subklavia kiri. Tindakan dilanjutkan dengan insisi median sternotomy yang diperluas ke arah supraklavikula kiri, ditemukan rupture total dari arteri subklavia kiri dengan jarak 1,5 cm proksimal dari arkus aorta. Tindakan repair (perbaikan) arteri secara primer (end to end anastomosis) dilakukan dengan hasil baik. (JKS 2017; 2: 105-114)Kata kunci : Trauma tumpul toraks, hematotoraks massif, cedera arteri subklavia kiriAbstract. Blunt thoracic trauma highest incidence is in adult, 20% to 50 % of the trauma cause death. Injuries to the vascular structures of the thoracic outlet, especially left subclavian artery, are rare and typically accompanied by massive hemorrhage. Close observation of vital sign and serial chest x-ray are very important. We describe an unusual presentation of a patient who suffered traumatic rupture of left subclavian artery. No clinical presentation of supraclavicular hematoma, unilateral absence of radial artery pulse and mediastinal widening in chest x-ray was found, but there is a massive hemothorax. Left posterolateral thoracotomy was performed, the source of bleeding was found in the apex of the lung, suspected a rupture of the left subclavian artery. The procedure continued with median sternotomy extended to left supraclavicular incision, a rupture was found in the left subclavian artery, 1,5 cm proximal to aortic arch. Primary repair was done with a good result. (JKS 2017; 2: 105-114)Key Words : Blunt thoracic trauma, massive hemothorax, left subclavian artery rupture

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LEFT SUBCLAVIAN ARTERY RUPTURE DUE TO BLUNT THORACIC TRAUMA: A CASE REPORT

Jurnal Kedokteran Syiah Kuala ◽

10.24815/jks.v18i2.17999 ◽

2018 ◽

Vol 18 (2) ◽

pp. 93-100

Author(s):

Yopie Afriandi Habibie ◽

Ign Wuryantoro

Keyword(s):

Subclavian Artery ◽

Thoracic Trauma ◽

Left Subclavian Artery ◽

Primary Repair ◽

Median Sternotomy ◽

Traumatic Rupture ◽

Blunt Thoracic Trauma ◽

X Ray ◽

Massive Hemothorax ◽

Chest X Ray

Abstract. Blunt thoracic trauma highest incidence is in adult, 20% to 50 % of the trauma cause death. Injuries to the vascular structures of the thoracic outlet, especially left subclavian artery, are rare and typically accompanied by massive hemorrhage. Close observation of vital sign and serial chest x-ray are very important. We describe an unusual presentation of a patient who suffered traumatic rupture ofleft subclavian artery. No clinical presentation of supraclavicular hematoma, unilateral absence of radial artery pulse and mediastinal widening in chest x-ray was found, but there is a massive hemothorax. Left posterolateral thoracotomy was performed, the source of bleeding was found in the apex of the lung, suspected a rupture of the left subclavian artery. The procedure continued with median sternotomy extended to left supraclavicular incision, a rupture was found in the left subclavian artery, 1,5 cm proximal to aortic arch. Primary repair was done with a good result. Key Words : Blunt thoracic trauma, massive hemothorax, left subclavian artery rupture

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Transfusion-Associated Circulatory Overload (Taco) Presentations In Pediatric Patients

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqab191.341 ◽

2021 ◽

Vol 156 (Supplement_1) ◽

pp. S160-S160

Author(s):

A Sallagonda ◽

C Andrzejewski

Keyword(s):

Case Series ◽

Mitigation Strategies ◽

Prior History ◽

Ivig Infusion ◽

Bowel Surgery ◽

Circulatory Overload ◽

Vulnerable Patient ◽

History Of ◽

Chest X Ray ◽

Male Neonate

Abstract Introduction/Objective Limited literature exists regarding Transfusion Associated Circulatory Overload(TACO) in children. Its clinical expressions compared to those in adults remains to be fully explored. We report two TACO cases in children <18 months of age describing their clinical presentations compared to those in older patients. Methods/Case Report Case series Results (if a Case Study enter NA) Case 1: 1.13 kg 18 day old male neonate (27 weeks premature) with anemia requiring hemotherapy(HT). He received 35 ml aliquot of Red Blood Cells(RBCs) which he tolerated well on postoperative day(POD) 1 after bowel surgery. On POD 2, he was transfused RBCs(18 mls). Within 15 minutes of HT initiation, marked elevations in blood pressure(BP) were noted. Workup for a suspected transfusion reaction(STR) was initiated. Blood Bank studies revealed vital sign value(VSV) changes similarly seen in adults with TACO(Transfusion: 52; 2311, 2012). NT-proBNP levels post HT were markedly elevated (8,000 and 64,000 pg/ml).Case 2: 17 month old(11 kg) female with a three weeks prior history of COVID-19 admitted with fever/dehydration and subsequently diagnosed with multisystem inflammatory syndrome in children (MIS-C). Intravenous immunoglobulin(IVIG) infusion ordered and within 20 minutes of starting IVIG, she developed grunting. STR workup showed post HT BP/temperature elevations/chest X-ray with increased interstitial markings. Of note she had also received 1070 ml of intravenous fluids within 48 hours prior to HT. Elevated NT-proBNP levels pre/post HT were measured(17,121 pg/ml and 19, 824 pg/ml respectively). Symptoms improved with diuretics. Conclusion Children experiencing TACO can clinically manifest similarly as in adults with respect to BP elevations and pulmonary changes. Grunting may be an underappreciated manifestation of TACO in pts < 18 months of age. IVIG infusions used in the treatment of patients with MIS-C may present problematic fluid challenges. Recognition of and mitigation strategies for TACO risk factors in such patients may enhance HT safety in this vulnerable patient population.

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