What is it about?
A Contegra conduit was impalnted in a neonate to establish blood flow to the lungs. The baby was very small and the size of the available conduit was larger resulting in a mismatch between the baby's chest cavity and the conduit. As a result the conduit was protruding above the ridges of sternum. So when the sternum was approximated, as is done after completion of open heart surgery, the conduit was getting compressed thereby obstructing blood flow to lungs. The only bail out technique available to us was to lift the sternum up by attaching a weight to a suture that was taken through the baby's sternum mimicking a pulley mechanism . This increased the anteroposterior diameter of the chest cavity and could seat the conduit inside the chest without compression and any obstruction to blood flow.
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Why is it important?
At times when there is a patient-conduit size mismatch,especially in neonates where the chest is compliant, this sternal lift technique could be helpful
Perspectives
Its a technique that many clinicians think about but may not implement it. What is important is to 'think out of the box' and try to salvage rather than do something heroic.
Dr Madan Mohan Maddali
Department of Cardiac Anesthesia, National Heart Center, Toyal Hospital, Muscat, Oman
Read the Original
This page is a summary of: Induced Pectus Carinatum, Journal of Cardiac Surgery, March 2016, Wiley,
DOI: 10.1111/jocs.12734.
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