Surgical Repair of Congenital Sternal Cleft in an Adult to Prevent Traumatic Pericardial Rupture

Abstract

Isolated congenital sternal cleft in an adult is a very rare anomaly and few cases have been reported so far. Here we report on a successful repair of a sternal cleft associated with an anterior pericardial defect in an adult. A 20-year-old man presented with a bony defect in the inferior part of his sternum. Physical examination revealed an ovoid gap with a diameter of 5 cm in the distal part of the sternum. Pulsations of the heart could be easily seen through the defect. There were no associated anomalies. The patient underwent surgery for repair of the sternal cleft. A computed tomography scan of the chest confirmed the physical findings of an inferior sternal cleft involving approximately 50 % of the sternum. The result of echocardiography was normal. The postoperative period was uneventful. Direct complete closure without compromising cardiac function was achieved in this patient. At one-year follow-up, his sternal appearance was normal. According to the literature, the use of autogenous tissue is better than prosthetic material for reconstruction, with respect to both the risk of infection and the inability of prosthetic material to grow with the patient.