Congenital Sternal Cleft With Absence of Anterior Pericardium
The xyphoid process was present inferiorly with the defect
superiorly. After a midline incision, there was a notable absence of
pericardium anteriorly. The thymus was resected, and the PDA was
ligated. The inferior sternal portion was divided, and the edges were
excised in order to realign with the remaining costal cartilages.
Extensive pectoralis muscle flaps were created bilaterally, and the
mediastinal pleura was opened widely on each side. The chest wall was
aggressively mobilized off the diaphragm. Interrupted 2-0 Vicryl sutures
were placed to bring the costal edges together in the midline, followed
by pectoralis muscle reapproximation.
She was extubated successfully the next day and discharged home on postoperative day three. At one month follow-up, her sternum has been healing well without any clinical concerns.
Overall, sternal clefts are a rare diagnosis and a cardiac evaluation is necessary for complete workup. The authors advocate for early repair of such defects in order to allow primary closure in a tension-free manner. This can be accomplished by performing extensive chest wall mobilization so that attachments to the diaphragm are divided, both pleural spaces are opened widely, and extensive pectoralis muscle flaps are raised. Intracardiac pressure monitoring is recommended during chest wall reapproximation and closure.References
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