Ectopia cordis in an adult patient with COVID‐19: A case report and literature review

Complex management of ectopia cordis complicated by pentalogy of cantrell: Report of two cases and review of current evidence

INTRODUCTION AND IMPORTANCE

Ectopia cordis is a rare congenital anomaly characterized by the abnormal positioning of the heart outside the thoracic cavity, frequently associated with additional congenital defects such as those seen in Pentalogy of Cantrell. Due to the rarity and severity of these anomalies, timely diagnosis and appropriate management remain clinically challenging but critical for patient outcomes.

CASE PRESENTATION

We report two distinct cases of ectopia cordis managed at our institution. The first case presented with complete ectopia cordis and absence of the sternum, requiring initial management with a Bogota bag followed by placement of bovine pericardium; unfortunately, the patient succumbed to complications of sepsis and heart failure at 12 days of life. The second case involved partial ectopia cordis accompanied by features of Pentalogy of Cantrell, managed conservatively with a Bogota bag and spontaneous epithelialization, resulting in successful discharge with stable clinical status.

CLINICAL DISCUSSION

Management of ectopia cordis, especially when complicated by associated anomalies, presents significant surgical and clinical challenges. Survival rates remain low due to complications such as sepsis, cardiac instability, and limited thoracic cavity space. Utilization of biomaterials like bovine pericardium has shown promise in providing necessary cardiac protection when primary closure is not feasible. Early multidisciplinary intervention, involving neonatologists, pediatric cardiologists, and surgeons, is crucial for optimizing outcomes.

CONCLUSION

While prognosis for ectopia cordis remains poor, careful and individualized management strategies, including timely intervention and infection prevention, can lead to favorable outcomes as demonstrated in our second case. This underscores the importance of a multidisciplinary approach and early prenatal diagnosis in enhancing survival rates for this rare condition.

Ectopia cordis with multiple ventricular septal defect and sternal cleft in a newborn: a case report

Ectopia cordis is a rare type of malformation where the heart is not located normally. It may be partially or completely located outside the thoracic cavity and can be associated with other congenital abnormalities.

CASE PRESENTATION

This case report is of a 34-week- and 6-day-old female fetus with a birth weight of 2040 g, a height of 41 cm, and a head circumference of 32 cm. The initial physical examination revealed a responsive newborn with an externalized heart outside the chest, with pericardium protection. In addition, a thoracic wall defect was detected suggesting incomplete formation of the septum bone. Moreover, in this case, the echocardiography report showed a multiple ventricular septal defect.

CONCLUSION

The management of ectopia cordis is a challenge for any obstetrician and pediatric surgeon due to its rarity. It causes mental agony and anxiety to the parents. With an early diagnosis, termination of pregnancy can be one of the options. Once it is diagnosed late, it needs a multidisciplinary approach, and the services of a very experienced pediatric surgeon to improve the prognosis.

Omphalocele and Cardiac Abnormalities-The Importance of the Association

Omphalocele is the most common ventral abdominal wall defect. Omphalocele is associated with other significant anomalies in up to 80% of cases, among which the cardiac ones are the most frequent. The aim of our paper is to highlight, through a review of the literature, the importance and frequency of association between the two malformations and what impact this association has on the management and evolution of patients with these pathologies. We reviewed the titles, the available abstracts, and the full texts of 244 papers from the last 23 years, from three medical databases, to extract data for our review. Due to the frequent association of the two malformations and the unfavorable effect of the major cardiac anomaly on the prognosis of the newborn, the electrocardiogram and echocardiography must be included in the first postnatal investigations. The timing of surgery for abdominal wall defect closure is mostly dictated by the cardiac defect severity, and usually the cardiac defect takes priority. After the cardiac defect is medically stabilized or surgically repaired, the omphalocele reduction and closure of the abdominal defect are performed in a more controlled setting, with improved outcomes. Compared to omphalocele patients without cardiac defects, children with this association are more likely to experience prolonged hospitalizations, neurologic, and cognitive impairments. Major cardiac abnormalities such as structural defects that require surgical treatment or result in developmental delay will significantly increase the death rate of patients with omphalocele. In conclusion, the prenatal diagnosis of omphalocele and early detection of other associated structural or chromosomal anomalies are of overwhelming importance, contributing to the establishment of antenatal and postnatal prognosis.