Immediate operation for ectopia cordis

Pentalogy of Cantrell with a single-ventricle cardiac defect: collaborative management of a complex disease

We present a case of ectopia cordis with a complex single-ventricle congenital heart defect in association with pentalogy of Cantrell. Management by a skilled multidisciplinary team was critical for patient survival. Early fetal diagnosis and the use of advanced imaging techniques allowed adequate time for planning and identified critical anatomic details. Preserving the heart's natural covering, performing cardiac surgery without cardiopulmonary bypass, and using catheter intervention decreased the risk to the patient. Complete coverage of the defect was achieved using skin generated with tissue expanders. This case illustrates the importance of collaboration when caring for infants with critical, high-risk disease and highlights the increased potential for survival with complex ectopia cordis in the current medical era.

[Ectopia cordis and cardiac anomalies]

Ectopia cordis is a rare disease that occurs in 5.5 to 7.9 per million live births. Only 267 cases had been reported as of 2001, most (95%) associated with other cardiac anomalies. We studied the cardiac malformations associated in 6 patients with ectopia cordis. Depending on where the defect was located, the cases of ectopia were classified into four groups: cervical, thoracic, thoraco-abdominal, and abdominal. All 6 patients died before the third day of life, 4 during delivery. Three of the patients were included in the thoracic group, whereas the other 3 belonged to the thoraco-abdominal group. All the patients had associated ventricular septal defects, 3 double-outlet right ventricle (50%) and the rest (50%) tetralogy of Fallot-pulmonary atresia. Two patients with double-outlet right ventricle presented mitral-valve pathology, a parachute valve and an atresic mitral valve. None of these cardiac anomalies have been reported to date.

Morphological aspects of ectopia cordis: four case reports and a review of the literature

Ectopia cordis is a rare congenital anomaly. We present 4 cases of ectopia cordis, 1 of which is the first report of an affected fetus in a triplet pregnancy. The morphological relationship between the types of ectopia cordis and their outcomes were investigated in all 4 cases. In addition, the literature on ectopia cordis in Japan was reviewed and discussed.

Complete thoracic ectopia cordis with double-outlet right ventricle: neonatal repair

A case of total thoracic ectopia cordis with double-outlet right ventricle and ventricular septal defect is presented. Prenatal diagnosis allowed single-stage correction immediately after birth. This approach proved to be technically feasible. Death occurred on the twelfth postoperative day owing to sepsis unrelated to the repair.

Ectopia cordis and the radiographic changes of a new surgical repair technique

Preliminary repair of the midline thoracic defect in a newborn with ectopia cordis entailed the use of a prosthetic silo and fluid-filled tissue expanders placed under the lateral chest wall. On post-operative radiographs these expanders simulated the appearance of massive subcutaneous oedema of the chest wall.

Neonatal septum transversum diaphragmatic defects

Over 10 years, 8 infants required surgery for central diaphragmatic herniation. Contrast peritoneography and technetium-99m-sulfur colloid radionuclide scanning were the most definitive diagnostic aids. Associated anomalies included variations of the pentalogy of Cantrell. A midline gastroduodenal loop was found in two infants. Six infants are alive and well 6 months to 3 years postoperatively. An abdominal approach is preferred if there is an intestinal hernia, associated gastrointestinal anomalies, or if a bilateral defect is present.

Thoracoabdominal ectopia cordis in a twin. A case report

Thoracoabdominal heart is a subgroup of the rare ectopia cordis complex. It may be part of an unusual syndrome with multiple abnormalities involving the anterior abdominal wall, sternum, diaphragm, pericardium and heart. A twin who died immediately after delivery showed four of the five defects in this syndrome.

Staged repair of ectopia cordis

Ectopia cordis is a challenging congenital anomaly that generally has defied repair because of the magnitude of the deformity and the associated defects, particularly the intracardiac anomalies. We were fortunate to be presented with a boy who had successfully undergone an operation on the day of his birth to provide skin coverage over his bare ectopic heart. Subsequent studies disclosed no intracardiac anomalies. This paper describes the second stage of his repair designed to place the heart within the thorax and construct a bony shield anterior to it.