Complete congenital sternal cleft associated with pectus excavatum

Abstract

We report herein a rare case of complete congenital sternal cleft (absent sternum) and anterior pericardial defect in association with pectus excavatum. In neonates with absent sternum, the sternal bars can be easily approximated by simple suture, due to the flexibility of the cartilaginous thorax. There is also little danger of cardiac compression when the repair is performed early in life. If reconstruction is delayed, the increased rigidity of the chest wall and the physiologic accommodation of the thoracic organs to the circumference of the chest render simple approximation impossible, without serious compromise of the heart and lungs. Our patient was a 13-year-old girl, whose case was particularly unusual because of the association of sternal cleft with pectus excavatum. After surgical correction of the pectus excavatum, we were able to construct a sternum by incising the lateral border of each sternal bar, thereby creating flaps that we sutured together at midline. The sternal bars were then approximated by loops of nonabsorbable suture around their circumference. The patient had an uncomplicated course, and at the 12-month follow-up visit, her sternal appearance was normal.

Fig. 1 Preoperative photograph of the patient's anterior chest wall shows complete sternal cleft.

Fig. 2 Spiral computed tomographic scan of the chest, with 3-dimensional reconstruction, shows the complete sternal cleft.

Fig. 3 A and B) To correct the pectus excavatum deformity, the abnormal cartilages were excised bilaterally, beneath the perichondrium. The periosteum of the each sternal bar was then incised on its lateral border, creating flaps that were sutured together in the midline with absorbable sutures. C) The 2 sternal bars were approximated with nonabsorbable sutures.

Fig. 4 Postoperative spiral computed tomographic scan of the thorax, with 3-dimensional reconstruction, shows the successful result.