Sternal cleft

Very rare: around 1/50.000. Dysraphism of the median line present at the 3rd month of gestation. It may be complete or partial (superior, median or inferior). It can be isolated or associated with other anomalies of the anterior body wall as in case of cardiac ectopy  or Cantrell pentalogy (see this term). It can also be found in PHACE syndrome (see this term). An early surgical correction is indicated to avoid the ribcage instability linked to the breathing movements as wll as any damage to the mediastinal organs. Surgical treatment must be early in order to improve respiratory dynamics and protect the mediastinum from trauma. Late surgeries are more complex.


Anesthetic implications: 

echocardiography; in case of complete cleft, paradoxical respiration is present as long as the defect is corrected; invasive hemodynamic monitoring during closure of the thoracic wall  at the end of surgery (as to tamponade); the approximation of the thoracic edges must be progressive


References : 

-        Beuderley M, Gauthier T, Bedu A, Fourcade L.
Fente sternale : intérêt dune prise en charge chirurgicale néonatale.
Arch Pédiatr 2010; 17: 1477-9

-        Acastello E, Majluf R, Garrido P, Barbosa LM, Peredo A.
Sternal cleft: a surgical opportunity.
J Pediatr Surg 2003; 38: 178-83.

-        Kumar R, Mohammed S, Biyani G, Karnawat R.
Sternal cleft : anaesthetic management of a rare congenital anomaly.
Indian J Anaesth 2015; 59:523-5

-        Nichols JH, Nasr VG.
Sternal malformations and anesthetic management.
Pediatr Anesth 2017 ; 27 : 1084-70.


Updated: October 2019