Congenital Sternal Cleft with Patent Ductus Arteriosus: Report of a Case

We report a rare case of a congenital sternal cleft. The patient was a full-term baby girl with a superior incomplete sternal cleft with patent ductus arteriosus (PDA). A primary repair of the sternum and ligation of the PDA were performed during the neonatal period without cardiac compression. Primary repair during the neonatal period is the optimal procedure for cases of congenital sternal cleft. Received: December 25, 2000 / Accepted: July 17, 2001     

Experience of sternal secondary closure by means of a titanium fixation system after transverse thoracosternotomy

Sternal dehiscence is a common complication after transverse thoracosternotomy in patients undergoing bilateral sequential lung transplantation (BSLT). These patients can be treated with conservative therapy, but severe dehiscence requires surgical reapproximation and secondary closure of the sternum. Seventy-one cases of patients who underwent BSLT between January 2007 and May 2009 were reviewed retrospectively. Out of 71 patients, the sternum was intact in two cases due to the use of bilateral anterolateral thoracotomy, and a clamshell incision had been utilized in 69 patients. Four patients (6.8%) presented with persistent chest pain with severe sternal dehiscence diagnosed by chest X-ray and/or chest computed tomography, and underwent sternal reapproximation using the Synthes Titanium Sternal Fixation System for longitudinal sternal plating. All four patients had successful sternal realignment and resolution of their preoperative clinical symptoms. No perioperative or postoperative complications were observed. The Synthes Titanium Sternal Fixation System is an appropriate and effective method for internal fixation of the sternum when used for symptomatic severe sternal dehiscence after sequential BSLT via transverse thoracosternotomy.     

Sternal malformations and anesthetic management

Shamberger and Welch classify sternal malformations into four types: thoracic ectopia cordis, cervical ectopia cordis, thoraco‐abdominal ectopia cordis, and cleft sternum. Cleft sternum is the most common subset, with a reported incidence of 1 in 50,000 to 100,000 live births, representing 0.15% of all anterior chest wall malformations. Acostello et al further classify cleft sternum into complete or partial (superior, medium, inferior) with a simple superior partial cleft sternum being by far the most common with an orthotopic heart, intact pericardium, and normal skin coverage. Associated anomalies with superior partial cleft sternum are rare, but can include cervicofacial hemangiomas, midline raphe from the tip of the cleft to the umbilicus, and PHACES (posterior fossa malformations, facial hemangiomas, arterial anomalies with coarctation of aorta, cardiac defects, eye abnormalities, sternal cleft, and supraumbilical raphe) syndrome. The more rare inferior partial clefts are associated with thoraco‐abdominal ectopia cordis as part of the Pentalogy of Cantrell (omphalocele, anterior diaphragmatic hernia, sternal cleft, ectopia cordis, ventricular septal defect/left ventricular diverticulum). This review summarizes the current knowledge of all four types of sternal malformations, and provides guidance for optimal anesthetic and perioperative care of these children.     

Surgical repair of incomplete cleft sternum and cardiac anomalies in early infancy

Congenital cleft sternum is a rare congenital anomaly due to lack of fusion of the lateral mesodermal plates. We report two cases of incomplete superior cleft sternum associated with cardiac anomalies that underwent successful complete surgical correction.     

Surgical strategy for impending rupture of an infected anastomotic pseudoaneurysm of the aorta 9 years after a Bentall procedure: radical surgery involving en bloc resection of the infected sternum,pseudoaneurysm, and artificial vascular graft

Infection of the sternum and anterior mediastinitis after open heart surgery are serious complications that are intractable with high case fatality rates. Frequently, infection spreads to an artificial foreign body in the mediastinum, causing difficulties with treatment. We report a case of infected pseudoaneurysm of the aorta at the anastomotic site of the artificial vascular graft. The infection spread from sternal osteomyelitis 9 years 5 months after aortic root replacement (Bentall procedure) for acute aortic dissection. We performed radical surgery that included en bloc resection of the infected sternum, pseudoaneurysm, and artificial vascular graft, with successful results. We report here the surgical strategy including the approach.     

Thymectomy to achieve primary closure of total sternal cleft

Total sternal cleft is a rare congenital malformation that may represent a challenge for the surgeon. In neonatal period, the primary closure is usually achievable, but at older age, this can be impossible. Moreover, the closure of the 2 sternal bars can bring to an exaggerated compression on mediastinal structures. Many different techniques for the treatment of sternal clefts have been reported in literature. We describe one case of total sternal cleft repaired at 4 months of age in which a partial thymectomy was performed to achieve the primary closure. We suggest considering this simple procedure in selected patients to reduce the risk of mediastinal compression.     

Increased kyphosis by a combination of fractures of the sternum and thoracic spine

A 67-year-old patient suffered a fall and sustained injuries to the thorax, combined with fractures of the ribs, sternum and thoracic spine. Her pre-existing kyphosis (caused by osteoporotic vertebral collapse) increased in severity. There was a clear relationship between a sternal fracture, deterioration of thoracic kyphosis and a fracture of the thoracic spine. Received: 7 December 1996 Revised: 5 May 1997 Accepted: 26 May 1997     

Complete cleft sternum.

A case of complete cleft sternum is presented along with the nomenclature of sternal defects. It is recommended that the term ectopia cordis should be applied only to cases in which the heart and thoracic viscera are genuinely ectopic. Surgical correction of complete cleft sternum should be performed in the neonatal period whether the infant is symptomatic or not. Simple closure of the defect, as for a median sternotomy, is possible during the first month of life and this avoids the more complex reconsructions necessary in older children.     

Congenital sternal cleft.

A cleft of the sternum is a rare congenital anomaly. We present a case of a sternal cleft in a 7-year-old boy. A split iliac bone graft covered with the sternocostal portion of a pectoralis major flap was used to reconstruct the defect.     

Superior sternal cleft repair using autologous rib grafts in an infant with complex congenital heart disease

We report the case of an infant with superior cleft sternum and obstructed type III (infra-diaphragmatic) total anomalous pulmonary venous return. A previously undescribed approach is presented using autologous rib grafts without division of the intact inferior sternum. This technique provides protection of the anterior and superior mediastinum without the use of foreign material, destabilization of the sternum, or compromise of respiratory mechanics.     

Congenital cleft sternum

The embryonic development of the sternum is discussed in an effort to explain the pathogenesis of cleft sternum (fissura sterni congenita). The treatment of one patient with such an anomaly is described. The operative indication, operative technique, and timing of the correction are discussed in some detail.     

Congenital bifid sternum. Report of an unusual case

This article presents the case of a child with an unusual type of cleft sternum characterized by fusion superiorly between the clavicles and inferiorly at the xiphoid with wide intervening separation. The defect was successfully corrected at age 17 months by surgical closure of the cleft primarily, which had not been achieved previously in a patient at this late age.     

Surgical management of the cleft sternum

Cleft sternum is a rare disturbance of unknown origin in the normal central midline fusion. Three cases of upper cleft sternum are reported here, one associated with a pericardium to the skin sinus tract. Surgical correction of this anomaly in the neonatal period is advised, whether the infant is symptomatic or not. Simple closure of the defect during the first month of life avoids the more complex reconstruction necessary in older children.     

Autologous repair of isolated complete sternal cleft in an adolescent

Isolated sternal clefts are rare congenital anomalies. Complete clefts are rarer still with only 23 cases being reported. We present an adolescent girl with a complete sternal cleft. The cleft was treated with autologous anterior perichondrial flaps and pectoralis advancement flaps.     

Surgical repair of combined gastroschisis and sternal cleft

We present a case of prenatally diagnosed gastroschisis combined with a sternal cleft, as well as the successful surgical management of this unusual condition. Successful management of gastroschisis combined with sternal cleft has not been reported before in the literature.     

Complete sternal cleft in an adult: case report

A cleft of the sternum is a rare congenital anomaly. We report a rare case of complete sternal cleft in a 25-year-old woman. After surgical correction of the pectus excavatum, complete closure by direct approximation of the freshened sternal remnants to the midline, without interposition of tissue graft or inert prosthesis, was achieved in our patient. The functional and cosmetic result was excellent after complete healing.     

Bifid sternum: neonatal surgical treatment

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.     

Congenital sternal cleft. Diagnosis and treatment

The first known case of sternal cleft was described by Torres in 1740. Since then, many publications have appeared concerning sternal cleft, which have led to introduce a classification and some therapeutical procedures. This disease is a developmental anomaly of the sternum that usually shows vascular and cardiac malformations as well as diaphragmatic, abdominal wall, pericard and middle line organs anomalies. Two cases of sternal cleft are presented who have been treated in the neonatal period with different associated anomalies. Diagnostic procedures and therapeutical aspects are discussed.     

Primary repair of a sternal cleft in an infant with autogenous tissues

A cleft sternum is a rare congenital anomaly often diagnosed as asymptomatic at birth. Clinical outcome may be unfavorable when an associated anomaly, particularly an intracardiac anomaly coexists with the defect. Primary repair should be employed in the neonatal period because the flexibility of the chest wall is maximal and compression of underlying structures is minimal. However, patients with sternal cleft may even present late in the childhood or adolescence period. We herein report a case of a 4-year-old girl with sternal cleft who showed a favorable clinical outcome following successful primary surgical repair with the use of autogenous tissues.