Abstract
We present a female neonate with a sternal cleft (SC) and additional aortic aneurysm who presented with respiratory failure. Stabilization of the SC was achieved by using the xyphoid process as an autologous graft bridging the upper part of the SC. We conclude that a step-wise correction of the SC with the use of an autologous graft may improve respiratory function, and should be considered when complete surgical correction is not feasible.
Highlights
Case ReportThe occurrence of a sternal cleft (SC) is very rare in children,[1,2] and may be associated with several clinical problems;[3] most importantly, respiratory dysfunction secondary to disturbances in respiratory mechanics
We present a female neonate with a sternal cleft (SC) and additional aortic aneurysm who presented with respiratory failure
A very few reports have been published that reported a combination of SC with aortic aneurysms (AA).[4,5,6,7,8]
Summary
The occurrence of a sternal cleft (SC) is very rare in children,[1,2] and may be associated with several clinical problems;[3] most importantly, respiratory dysfunction secondary to disturbances in respiratory mechanics. In the following diagnostic workup, echocardiography and CT [►Supplementary Fig. S1 (online only)] confirmed the diagnosis of an aneurysm of the ascending aorta (diameter of 14 mm, z-score þ4.75) and SC. By this maneuver, the lower two-thirds of the cleft were approximated. Immediately after closure of the cleft the neonate developed cardiopulmonary instability. The XP was moved to the mid of the cleft and fixed by sutures (3–0 monofilament absorbable suture; Polydioxanone, PDS II, Ethicon, Somerville, NJ United States) to stabilize the thoracic anterior wall and to improve thoracic motility with no recurrence of cardiovascular instability (►Fig. 2). There is no increased susceptibility for pulmonary infections, cardiac function is nearly normal, and the diameter of the ascending aorta decreased in size ( z-score of þ2.6). Online content including video sequences viewable at: www. thieme-connect.com/products/ejournals/html/ 10-1055-s-0037-1604049-EJPSR-17-0322-CG-v1.mp[4]
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