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Sulistyowati R, Sensusiati AD. Radiological findings of partial expression pentalogy of Cantrell and other multiple congenital anomalies: A rare case report. Radiol Case Rep 2022; 17:3172-3178. [PMID: 35801122 PMCID: PMC9253550 DOI: 10.1016/j.radcr.2022.05.083] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2022] [Revised: 05/25/2022] [Accepted: 05/28/2022] [Indexed: 11/08/2022] Open
Abstract
Pentalogy of Cantrell is a rare syndrome of anomalous malformation. In the present case, the syndrome was initially diagnosed as a complete pentad, including a supra-umbilical abdominal wall defect, a sternal defect, pericardial defects, an anterior diaphragmatic defect, and heart malformation. Diagnosis required several imaging modalities, including computed tomography (CT) and magnetic resonance imaging (MRI). In this case report, we present an 8-month-old female patient with a thoracic wall defect with ectopia cordis and a bilateral cleft lip and palate. In addition, a head CT scan showed craniosynostosis, hypogenesis of the corpus callosum, and tonsillar cerebellar herniation. Thoracoabdominal CT revealed herniation of the transverse colon up to the subcutaneous layer, diaphragmatic hernia, atrial septal defects (ASD), ventral septal defects (VSD), and a persistent left superior vena cava (PLSVC). A multidisciplinary approach is required for the optimal management of this syndrome. We describe a female infant who presented with pentalogy of Cantrell syndrome and include the findings from postnatal CT imaging.
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Ectopia Cordis as a Lethal Neonatal Condition: A Case Report from Bahrain and a Literature Review. Case Rep Pediatr 2022; 2022:6850305. [PMID: 36045723 PMCID: PMC9424026 DOI: 10.1155/2022/6850305] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 07/19/2022] [Accepted: 07/27/2022] [Indexed: 11/17/2022] Open
Abstract
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. It results from failure of maturation of midline mesoderm and ventral body formation during embryogenic formation. The exact etiology remains unknown. The literature review reveals the prognosis for infants with ectopia cordis is very poor. Here, we are reporting the first case of a fetus that was prenatally diagnosed with ectopia cordis that was associated with omphalocele documented in our country. Considering the poor prognosis for the fetus, conservative management during the prenatal period was chosen.
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Palencia Palacios M, Fajardo Idrobo BV, López Mosquera LM, Álvarez Soler JA. Pentalogy of Cantrell. A stillbirth case report. CASE REPORTS 2022. [DOI: 10.15446/cr.v8n1.91323] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Introduction: Pentalogy of Cantrell is a rare congenital disorder characterized by midline birth anomalies. Its embryological origins are related to anomalies of the abdominal wall that prevent the closure of the thorax. Its etiology is not yet clear, but it has been associated with a failure of migration of the lateral plate mesoderm to the midline.
Case description: A stillbirth at 25.2 weeks of gestation diagnosed with pentalogy of Cantrell. The mother was a 14-year-old teenager with no relevant history of disease. An obstetric ultrasound was performed at 19 weeks of gestation and revealed findings suggestive of pentalogy of Cantrell. The mother was informed of the potential risks and future complications for the fetus, yet she chose to continue with the pregnancy. At 25.2 weeks of gestation, the mother went to the emergency department due to pain in the hypogastrium accompanied by moderate vaginal bleeding and absence of fetal activity. Once fetal death was confirmed by ultrasound, labor was induced, resulting in stillbirth with anencephaly, thoracic hypoplasia, gastroschisis, and eventration of the liver.
Conclusions: Adequate antenatal care, including strict ultrasound follow-up, is essential to detect future complications in the fetus; to provide advice on possible malformations incompatible with life, such as pentalogy of Cantrell; and to determine the best therapeutic approach.
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Bako D, Epçaçan S, Giray D, Karakuş Epçaçan Z. Congenital biventricular cardiac diverticula as a part of class III Cantrell's syndrome: case report. Cardiol Young 2022; 33:1-3. [PMID: 35438064 DOI: 10.1017/s1047951122001238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
Congenital cardiac ventricular diverticulum is an extremely rare condition that usually occurs as a part of Pentalogy of Cantrell and frequently associated with sternal, pericardial, diaphragmatic, and thoracoabdominal wall defects. The prognosis of the patient depends on the complexity of abnormalities. Herein, we report biventricular diverticula as a part of incomplete Cantrell's syndrome in a 1-day-old newborn.
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Affiliation(s)
- Derya Bako
- University of Health Sciences, Van Training and Research Hospital, Department of Paediatric Radiology, Van, Turkey
| | - Serdar Epçaçan
- University of Health Sciences, Van Training and Research Hospital, Department of Paediatric Cardiology, Van, Turkey
| | - Dilek Giray
- University of Health Sciences, Van Training and Research Hospital, Department of Paediatric Cardiology, Van, Turkey
| | - Zerrin Karakuş Epçaçan
- University of Health Sciences, Van Training and Research Hospital, Department of Paediatrics, Van, Turkey
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Kokkinos P, Pratschke K. Combined pentalogy of Cantrell with ectrodactyly and surgical implant‐free repair of a sternal cleft and supraumbilical hernia in an adult cat. VETERINARY RECORD CASE REPORTS 2022. [DOI: 10.1002/vrc2.364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
- Panagiotis Kokkinos
- Small Animal Referrals Animal Health Trust Newmarket Suffolk UK
- Southfields Veterinary Specialists Southfields Laindon Essex UK
| | - Kathryn Pratschke
- Small Animal Referrals Animal Health Trust Newmarket Suffolk UK
- Veterinary Clinical Services The Royal (Dick) School of Veterinary Studies Midlothian UK
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Complete and Incomplete Pentalogy of Cantrell. CHILDREN-BASEL 2019; 6:children6100109. [PMID: 31590448 PMCID: PMC6826365 DOI: 10.3390/children6100109] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2019] [Revised: 09/29/2019] [Accepted: 10/03/2019] [Indexed: 11/17/2022]
Abstract
Pentalogy of Cantrell (PC) is a malformation characterized by defects in the ventral abdominal wall, lower sternum, diaphragmatic pericardium, anterior diaphragm associated with omphalocele, thoraco-abdominal ectopia cordis, diaphragmatic hernia, and intracardiac abnormalities. PC is stratified as complete or incomplete and we present both the complete and incomplete forms.
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Taee N, Goodarzi MF, Safdari M, Bajelan A. Pentalogy of Cantrell in Full Term Neonate. AJP Rep 2019; 9:e144-e146. [PMID: 30972230 PMCID: PMC6456328 DOI: 10.1055/s-0039-1683936] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Accepted: 12/30/2018] [Indexed: 10/28/2022] Open
Abstract
Pentalogy of Cantrell (PC) is an uncommon congenital disorder characterized by severe defects in the chest and abdomen, including abdominal visceral prolapsed via umbilical cord (omphalocele), defect in the lower part of the sternum, defect in the front of the diaphragm, defects in the anterior part of the pericardium, and the ectopiacordis. Here, we report a 2-hour-old girl, weighing 3,500 g, who was referred to Shahid Madani Hospital in Khorramabad due to the large omphalocele on her chest with pulsating mass above it. The baby was the first child of a 24-year-old mother who was born with an uncomplicated vaginal delivery. Very rare cases of PC are born as a term new-born.
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Affiliation(s)
- Nadereh Taee
- Department of Pediatrics, Lorestan University of Medical Sciences, Khorramabad, Iran
| | | | - Mohammad Safdari
- Medical Student, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Amir Bajelan
- Medical Student, Lorestan University of Medical Sciences, Khorramabad, Iran
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Hubbard R, Hayes S, Gillis H, Lindsey S, Malhotra P, Wani T, Tobias JD, Beltran R. Management Challenges in an Infant With Pentalogy of Cantrell, Giant Anterior Encephalocele, and Craniofacial Anomalies: A Case Report. A A Pract 2019; 11:238-240. [PMID: 29782331 DOI: 10.1213/xaa.0000000000000793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Pentalogy of Cantrell is a rare syndrome consisting of midline abnormalities involving the heart, sternum, abdominal wall, and the anterior and pericardial diaphragm. This combination of defects places patients at particular perioperative risk and requires individualized management during anesthetic care. The following report documents the management of a patient with pentalogy of Cantrell, whose condition was further complicated by severe midline craniofacial abnormalities, including large anterior encephalocele, deficient mandible, tethered tongue, and cleft palate. The case offers insight into the complexity of care in this unique patient population.
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Affiliation(s)
| | - Seth Hayes
- From the Department of Anesthesiology and Pain Medicine
| | | | - Spencer Lindsey
- Department of Otolaryngology, Nationwide Children's Hospital, Columbus, Ohio
| | - Prashant Malhotra
- Department of Otolaryngology, Nationwide Children's Hospital, Columbus, Ohio
| | - Tariq Wani
- From the Department of Anesthesiology and Pain Medicine
| | | | - Ralph Beltran
- From the Department of Anesthesiology and Pain Medicine
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Coleman PW, Marine MB, Weida JN, Gray BW, Billmire DF, Brown BP. Fetal MRI in the Identification of a Fetal Ventral Wall Defect Spectrum. AJP Rep 2018; 8:e264-e276. [PMID: 30377551 PMCID: PMC6205859 DOI: 10.1055/s-0038-1675353] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 09/17/2018] [Indexed: 02/06/2023] Open
Abstract
Objective To ascertain if useful criteria for prenatal diagnosis of fetal ventral body wall defects (VBWDs) exists by reviewing published literature on diagnosis of VBWD as compared with our own diagnostic experience. Study Design A comprehensive literature review of diagnostic criteria of fetal VBWD including pentalogy of Cantrell (POC), omphalocele, exstrophy, imperforate anus, spina bifida (OEIS), cloacal exstrophy, limb-body wall complex (LBWC), and body stalk anomaly was performed followed by a retrospective review of all fetal magnetic resonance imaging (MRI) examinations from our medical center over a 2-year period. Results Classically, OEIS is omphalocele, bladder exstrophy, imperforate anus, and spina bifida. POC is defects of the supraumbilical abdomen, sternum, diaphragm, pericardium, and heart. LBWC is two of the following: exencephaly or enencephaly with facial clefts, thoracoschisis or abdominoschisis, and limb defects. Twenty-four cases of VBWD on MRI over a 24-month period were identified with seven cases involving defects of additional organ systems. Six of these seven cases demonstrated findings from two or more of the traditional diagnoses POC, OEIS, and LBWC making diagnosis and counseling difficult. Conclusion There is a lack of consensus on useful diagnostic criteria within the published literature which is reflected in our own diagnostic experience and poses a challenge for accurate prenatal counseling.
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Affiliation(s)
- Peter W Coleman
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana
| | - Megan B Marine
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana
| | - Jennifer N Weida
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Brian W Gray
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Deborah F Billmire
- Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana
| | - Brandon P Brown
- Department of Radiology and Imaging Sciences, Indiana University School of Medicine, Indianapolis, Indiana
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Grigore M, Furnica C, Esanu I, Gafitanu D. Pentalogy of Cantrell associated with unilateral anophthalmia: Case report and literature review. Medicine (Baltimore) 2018; 97:e11511. [PMID: 30075516 PMCID: PMC6081174 DOI: 10.1097/md.0000000000011511] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
RATIONALE Pentalogy of Cantrell, a very rare congenital condition, has an estimated incidence of 5.5 per 1 million live births. It includes five defects: a midline supraumbilical wall defect, a diaphragmatic defect, a cleft distal sternum, a defect in the diaphragmatic pericardium, and an intracardiac defect. Very few cases of this condition have been reported in the literature, most of them diagnosed in the second or third trimester of pregnancy. PATIENT CONCERNS We present a case of pentalogy of Cantrell associated with cranioschisis and unilateral anophthalmia diagnosed at 14 weeks of amenorrhea. DIAGNOSES The combination of abdominal and vaginal sonography established the diagnosis of 14 weeks of amenorrhea with a plurimalformative syndrome including: ectopia cordis, large suprambilical anterior abdominal wall defect, omphalocele, anomaly of the shape of the skull, and anomalies of the brain. INTERVENTIONS After counseling the parents, the pregnancy was interrupted, as requested by the family. OUTCOMES Pathological examination of the fetus after the therapeutic abortion confirmed the diagnosis. LESSONS Because of the poor prognosis of Cantrell's pentalogy, early antenatal sonographic detection is important and allows for elective abortion before viability.
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Affiliation(s)
- Mihaela Grigore
- Department of Obstetrics and Gynecology Department of Anatomy Department of Internal Medicine, University of Medicine and Pharmacy, "Grigore T. Popa" Iasi, Romania
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Aldeiri B, Roostalu U, Albertini A, Behnsen J, Wong J, Morabito A, Cossu G. Abrogation of TGF-beta signalling in TAGLN expressing cells recapitulates Pentalogy of Cantrell in the mouse. Sci Rep 2018; 8:3658. [PMID: 29483576 PMCID: PMC5826924 DOI: 10.1038/s41598-018-21948-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Accepted: 02/12/2018] [Indexed: 01/21/2023] Open
Abstract
Pentalogy of Cantrell (PC) is a rare multi-organ congenital anomaly that impedes ventral body wall closure and results in diaphragmatic hernia, intra- and pericardial defects. The underlying cellular and molecular changes that lead to these severe developmental defects have remained unknown largely due to the lack of representative animal models. Here we provide in depth characterization of a mouse model with conditional ablation of TGFβRII in Transgelin (Tagln) expressing cells. We show that Tagln is transiently expressed in a variety of cells that participate in the embryonic development and patterning of ventral structures. Genetic ablation of TGFβRII in these cells leads to ventral midline closure defect, diaphragmatic hernia, dilated cardiac outflow tract and aberrant cardiac septation, providing a reliable model to study the morphological changes leading to PC. We show that myogenisis in the diaphragm is independent of TGFβ and the diaphragmatic hernia arises from fibroblast-specific migration defect. In the dorsal body wall Tagln expression is initiated after the closure process, revealing a remarkable difference between ventral and dorsal body walls development. Our study demonstrates the use of micro-CT scanning to obtain a 3-dimensional high-resolution overview of embryonic anomalies and provides the first mechanistic insight into the development of PC.
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Affiliation(s)
- Bashar Aldeiri
- Manchester Academic Health Science Centre, Division of cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK. .,Royal Manchester Children's Hospital, Manchester, UK.
| | - Urmas Roostalu
- Manchester Academic Health Science Centre, Division of cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
| | - Alessandra Albertini
- San Raffaele Telethon Institute for Gene Therapy (SR-TIGET), IRCSS, San Raffaele Scientific Institute, Milan, Italy
| | - Julia Behnsen
- Henry Moseley X-Ray Imaging Facility, The University of Manchester, Manchester, UK
| | - Jason Wong
- Manchester Academic Health Science Centre, Division of cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,Manchester University Hospitals, Wythenshawe Hospital, Manchester, UK
| | - Antonino Morabito
- Manchester Academic Health Science Centre, Division of cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK.,Royal Manchester Children's Hospital, Manchester, UK
| | - Giulio Cossu
- Manchester Academic Health Science Centre, Division of cell Matrix Biology and Regenerative Medicine, School of Biological Sciences, Faculty of Biology, Medicine and Health, The University of Manchester, Manchester, UK
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Kunapinun N, Treetipsatit J. Discordant Anomalies with Combined Features of Pentalogy of Cantrell and OEIS Complex: A Case Report in Monochorionic Twins. Fetal Pediatr Pathol 2017; 36:357-363. [PMID: 28617177 DOI: 10.1080/15513815.2017.1332122] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
INTRODUCTION Ventral body wall defects have various manifestations. Among others, pentalogy of Cantrell (PC) and omphalocele exstrophy imperforate anus spinal abnormalities (OEIS) complex are defects that involve upper and lower anterior midline of body wall, respectively. Although both entities are in a spectrum of ventral body wall defects, the combination of PC and OEIS complex has not been described. CASE REPORT In this report, we describe an unusual case of congenital ventral body wall defect with combined features of PC and OEIS complex, which discordantly occurred in monochorionic monoamniotic twins. CONCLUSION PC and OEIS complex may be related regarding their embryologic origins. The combination may represent the most severe manifestation of ventral body wall defects.
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Affiliation(s)
- Nique Kunapinun
- a Department of Pathology, Faculty of Medicine Siriraj Hospital , Mahidol University , Bangkok , Thailand
| | - Jitsupa Treetipsatit
- a Department of Pathology, Faculty of Medicine Siriraj Hospital , Mahidol University , Bangkok , Thailand
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Salinas-Torres VM, De La O-Espinoza EA, Salinas-Torres RA. Severe Intrauterine Amputations in One Dichorionic Twin With Pentalogy of Cantrell: Further Evidence and Consideration for Mechanical Teratogenesis. Pediatr Dev Pathol 2017; 20:440-443. [PMID: 28812462 DOI: 10.1177/1093526617689896] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pentalogy of Cantrell (PC) is characterized by midline supraumbilical abdominal wall defect, lower sternum defect, anterior diaphragmatic and pericardial defect, and congenital cardiac anomalies. Several etiological influences have been postulated, however, most of the reported cases are sporadic. In addition, evidence for mechanical teratogenesis in PC is limited. Here, we describe in one dichorionic twin with complete PC, additional severe intrauterine amputations (mainly head and neck) not previously reported resultant from mechanical teratogenesis. This morphologic constellation prompts us to emphasize the consideration of this etiological influence and provides further evidence. In fact, the pattern of anomalies in the affected fetus provides new insight into the severity and presentation of PC due to mechanical teratogenesis, which is a significant etiological consideration in clinical evaluation and implies that the syndrome involves a complex defective fetal development.
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Complete Ectopia Cordis: A Case Report and Literature Review. Case Rep Pediatr 2017; 2017:1858621. [PMID: 28503337 PMCID: PMC5414485 DOI: 10.1155/2017/1858621] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 03/16/2017] [Accepted: 03/26/2017] [Indexed: 12/03/2022] Open
Abstract
Ectopia cordis is a congenital heart exposure defined as complete or partial protrusion of heart through ventral defect in the thoracoabdominal wall alone or with other viscera in cases of pentalogy of Cantrell. This condition was first described by Haller et al. in 1706; since then many advances have been made. Diagnosis of ectopia cordis is done prenatally in well-equipped health facility by antenatal ultrasound scan so that early diagnosis and management plan can be initiated. The index case was delivered to uneducated rural family and admitted at 3 days of life and survived for seven days, even though most literatures state that majority died within four days even with surgery. So, in view of this, we presented this case report to deliberately draw the attention of paediatrician/obstetrician to the fact that even though this condition is rare, proactive search and diagnosis should be made and early treatment should be instituted, so that such a child may be salvaged.
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Engels AC, Debeer A, Russo FM, Aertsen M, Aerts K, Miserez M, Deprest J, Lewi L, Devlieger R. Pericardio-Amniotic Shunting for Incomplete Pentalogy of Cantrell. Fetal Diagn Ther 2017; 41:152-156. [PMID: 28196368 DOI: 10.1159/000457122] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
A 27-year-old woman, gravida 2, para 0, presented with an incomplete Pentalogy of Cantrell with an omphalocele, diaphragmatic hernia, and a pericardial defect at 32 weeks' gestation. A large pericardial effusion compressed the lungs and had led to a reduced lung growth with an observed-to-expected total lung volume of 28% as measured by MRI. The effusion disappeared completely after the insertion of a pericardio-amniotic shunt at 33 weeks. After birth, the newborn showed no signs of pulmonary hypoplasia and underwent a surgical correction of the defect. Protracted wound healing and a difficult withdrawal from opioids complicated the neonatal period. The child was discharged on postnatal day 105 in good condition. This case demonstrates that in case of Pentalogy of Cantrell with large pericardial effusion, the perinatal outcome might be improved by pericardio-amniotic shunting.
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Affiliation(s)
- Alexander C Engels
- Department of Development and Regeneration, Organ Systems, KU Leuven, Leuven, Belgium
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Wertelecki W, Chambers CD, Yevtushok L, Zymak-Zakutnya N, Sosyniuk Z, Lapchenko S, Ievtushok B, Akhmedzhanova D, Komov O. Chornobyl 30 years later: Radiation, pregnancies, and developmental anomalies in Rivne, Ukraine. Eur J Med Genet 2017; 60:2-11. [DOI: 10.1016/j.ejmg.2016.09.019] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2016] [Accepted: 09/29/2016] [Indexed: 11/24/2022]
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Kaul B, Sheikh F, Zamora IJ, Mehollin-Ray AR, Cassady CI, Ayres NA, Cass DL, Olutoye OO. 5, 4, 3, 2, 1: embryologic variants of pentalogy of Cantrell. J Surg Res 2015; 199:141-8. [DOI: 10.1016/j.jss.2015.04.017] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2015] [Revised: 03/21/2015] [Accepted: 04/03/2015] [Indexed: 11/28/2022]
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Abstract
BACKGROUND Pentalogy of Cantrell is a rare, congenital disorder characterized by lower sternal defects, diaphragmatic defect, pericardial defect, supraumbilical abdominal wall abnormalities, and/or intracardiac defects. The collective defects result from failure of either differentiation or migration of mesenchymal or mesodermal structures during the embryonic phase of development. Mortality of the disease complex is high, and treatment, when appropriate, revolves around surgical correction of the associated defects. PURPOSE This article presents a case of pentalogy of Cantrell and examines the literature to report the most current evidence relative to the embryology and pathophysiology. In addition, the methods of pre- and postnatal diagnosis, management, and prognostic indicators are examined. METHODS/SEARCH STRATEGY Case report was gathered from the medical records and is provided as it occurred. The literature was searched for evidence of best management strategies as well as care implications for families. FINDINGS/RESULTS A female newborn was delivered at (Equation is included in full-text article.)weeks' gestation secondary to premature onset of labor. Prenatal ultrasonography identified an abdominal wall defect, diaphragmatic hernia, sternal defect, ventricular septal defect, and open neural tube defect. Examination immediately after delivery confirmed prenatal findings and a diagnosis of pentalogy of Cantrell was assigned. IMPLICATIONS FOR PRACTICE Patients with the diagnosis of pentalogy of Cantrell should receive antenatal counseling relative to mortality and morbidity risks. An interprofessional approach in the immediate timeframe after delivery facilitates timely diagnostics and offers families prompt confirmation of antenatal findings. IMPLICATIONS FOR RESEARCH Future research can focus on further elucidating genetic etiologies of pentalogy of Cantrell.
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Abstract
Background Pentalogy of Cantrell is a rare syndrome, first described by Cantrell and co-workers in 1958. The syndrome is characterized by the presence of five major congenital defects involving the diaphragm, abdominal wall, the diaphragmatic pericardium, lower sternum and various congenital intra-cardiac abnormalities. The syndrome has never been reported in Tanzania, although may have been reported from other African countries. Survival rate of the complete form of pentalogy of Cantrell is as low as 20%, but recent studies have reported normal growth achieved by 6 years of age where corrective surgeries were done; showing that surgical repair early in life is essential for survival. Case presentation The African baby residing in Tanzania was referred from a district hospital on the second day of life. She was noted to have a huge omphalocele and ectopia cordis covered by a thin membrane, with bowels visible through the membrane and the cardiac impulse visible just below the epigastrium. Despite the physical anomaly, she appeared to saturate well in room air and had stable vitals. Her chest X-ray revealed the absence of the lower segments of the sternum and echocardiography showed multiple intra-cardiac defects. Based on these findings, the diagnosis of pentalogy of Cantrell was reached. On her fifth day of life, the neonate was noted to have signs of cardiac failure characterized by easy fatigability and restlessness during feeding. Cardiac failure treatment was initiated and she was discharged on parents’ request on the second week of life. Due to inadequate facilities to undertake this complex corrective surgery, arrangements were being made to refer her abroad. In the meantime, her growth and development was satisfactory until the age of 9 months, when she ran out of the medications and succumbed to death. Her parents could no longer afford transport cost to attend the monthly clinic visits, where the infant was getting free medication refill. Conclusions The case reported here highlights that in resource limited settings; poor outcome in infants with complex congenital anomalies is a function of multiple factors. However, we believe that surgery would have averted mortality in this 9-month-old female infant. We hope to be able to manage these cases better in future following the recent establishment of cardiac surgery facilities at Muhimbili National Hospital.
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Affiliation(s)
- Helga Naburi
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - Evelyne Assenga
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - Sonal Patel
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - Augustine Massawe
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
| | - Karim Manji
- Department of Paediatrics and Child Health, Muhimbili University of Health and Allied Sciences, Dar es Salaam, Tanzania.
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Lopez MM, Kuzma AB, Margiocco ML, Cheng T, Enberg TB, Head L. Cardiac malposition (ectopia cordis) in a cat. J Vet Emerg Crit Care (San Antonio) 2015; 25:783-8. [PMID: 26193979 DOI: 10.1111/vec.12342] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2012] [Revised: 11/01/2013] [Accepted: 05/20/2013] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To describe a case of cardiac malposition in a cat, and the successful management of the anomaly. CASE DESCRIPTION A 2-year-old male neutered male British Shorthair cat weighing 7.58 kg was referred for bicavitary effusion. Ultrasonography and echocardiography demonstrated displacement of the heart into the abdomen through a diaphragmatic defect. Clinical signs of right-sided congestive heart failure were attributed to mechanical restriction of diastolic function by a constrictive segment of fibrous pericardium and to impaired venous return due to a kink in the caudal vena cava. Surgical repositioning of the heart into the thoracic cavity and a subtotal pericardectomy were performed, and the diaphragmatic defect was repaired. The patient recovered well postoperatively. NEW OR UNIQUE INFORMATION PROVIDED The diagnosis and management of cardiac malposition has not been previously described in cats. With timely diagnosis and surgical intervention, a favorable outcome is possible.
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Affiliation(s)
- Melinda M Lopez
- Canada West Veterinary Specialists, 1988 Kootenay Street, Vancouver, British Columbia, V5M 4Y3, Canada
| | - Alan B Kuzma
- Canada West Veterinary Specialists, 1988 Kootenay Street, Vancouver, British Columbia, V5M 4Y3, Canada
| | - Marco L Margiocco
- Canada West Veterinary Specialists, 1988 Kootenay Street, Vancouver, British Columbia, V5M 4Y3, Canada
| | - Teresa Cheng
- Canada West Veterinary Specialists, 1988 Kootenay Street, Vancouver, British Columbia, V5M 4Y3, Canada
| | - Trevor B Enberg
- Canada West Veterinary Specialists, 1988 Kootenay Street, Vancouver, British Columbia, V5M 4Y3, Canada
| | - Laurie Head
- Canada West Veterinary Specialists, 1988 Kootenay Street, Vancouver, British Columbia, V5M 4Y3, Canada
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Shazly SAM, Abbas AM, Ali SS, Salem NZ. Integrative mid-trimester anomaly (IMTA) chart: a novel sonographic approach for syndromatic challenges (pilot study). J Matern Fetal Neonatal Med 2015; 29:885-91. [PMID: 25777576 DOI: 10.3109/14767058.2015.1021675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE To validate the use of the integrative mid-trimester anomaly (IMTA) chart, a novel chart that aims to increase sonographers' ability to diagnose fetal syndromes and complex anomalies. METHODS This study was conducted between September 2014 and January 2015. Pregnant women who attended our hospital for fetal medicine consultation during the second trimester were recruited. The diagnosis was assigned by a qualified consultant. The research coordinator randomized women between two groups (each consisted of two sonographers with comparable experience) and each was then examined twice (once with and once without the chart). Supposed diagnosis, patient and sonographer satisfactions were reported. RESULTS Twenty five women were recruited. Their average age was 26.48 ± 4.49 years and gestational age at examination was 24.39 ± 6.39. There were 17 (68%) fetuses that had multiple anomalies. The duration of examination was comparable. However, patient and sonographer satisfactions were higher when the same women were examined with the chart (p < 0.0001). The accuracy of diagnosis was also significantly higher (p = 0.03). CONCLUSION The IMTA chart seems to be a useful tool for novice sonographers that could increase their diagnostic accuracy and improve their patient and their own satisfaction.
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Affiliation(s)
- Sherif A M Shazly
- a Women's Health Hospital, Assiut University , Assiut , Egypt and.,b Division of Gynecology , Mayo Clinic , Rochester , MN , USA
| | - Ahmed M Abbas
- a Women's Health Hospital, Assiut University , Assiut , Egypt and
| | - Shymaa S Ali
- a Women's Health Hospital, Assiut University , Assiut , Egypt and
| | - Neima Z Salem
- a Women's Health Hospital, Assiut University , Assiut , Egypt and
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Ohlow MA, von Korn H, Lauer B. Characteristics and outcome of congenital left ventricular aneurysm and diverticulum: Analysis of 809 cases published since 1816. Int J Cardiol 2015; 185:34-45. [PMID: 25782048 DOI: 10.1016/j.ijcard.2015.03.050] [Citation(s) in RCA: 70] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Revised: 01/19/2015] [Accepted: 03/03/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Congenital left ventricular aneurysm (LVA) or diverticulum (LVD) is rare cardiac anomalies. We aimed to analyse the clinical characteristics and outcome in all ever published patients. METHODS MEDLINE, Web of science, Google and EMBASE, and reference lists of relevant articles were searched for publications reporting on LVA or LVD patients. RESULTS We identified 809 patients published since 1816 [354 (49.1%) LVA, 453 (50.6%) LVD, 2 (0.3%) both]. Mean age at diagnosis was 34.1±27 (LVA) and 29.7±27.6years (LVD; p=0.05). 48.9% were male. LVA was larger (38.7±22.5mm versus 31.4±21.2mm; p=0.002) and frequently found in submitral location (33% versus 4.9%; p<0.001), LVD was frequently located at the LV-apex (61.2% versus 28.7%; p<0.001). LVD was often associated with cardiac (34.2% versus 11%; p<0.001) or extracardiac anomalies (32.7% versus 3%; p<0.001). LVA patients presented more frequently with ventricular tachycardia/fibrillation (18.1% versus 13.1%; p=0.01), the incidences of rupture (4% versus 4.5%; p=0.9), syncope (8.3% versus 5.1%; p=0.1), and embolic events (4.9% versus 3.6%; p=0.4) at presentation were not different between LVA and LVD. Mean follow-up was 56.3±43months. Cardiac death occurred more frequently in the LVA group (11.5% versus 5.0%; p=0.05) at a median age of 0.8 [LVA] and 2.5 [LVD] years. The leading cause of cardiac death was congestive heart failure in the LVA-group (50.0% versus 0.0%; p=0.01), and rupture in the LVD-group (75.0% versus 27.3%; p=0.04). CONCLUSIONS LVA and LVD are distinct congenital anomalies with different clinical and morphological characteristics. The prognosis of LVA is significantly worse during long-term follow-up.
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Affiliation(s)
- Marc-Alexander Ohlow
- Department of Cardiology, Zentralklinik Bad Berka, Robert-Koch-Allee 9, 99437 Bad Berka, Germany.
| | - Hubertus von Korn
- Medizinische Klinik I, Krankenhaus Hetzelstift, Neustadt/Weinstrasse/Weinstrasse, Germany
| | - Bernward Lauer
- Department of Cardiology, Zentralklinik Bad Berka, Robert-Koch-Allee 9, 99437 Bad Berka, Germany
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Pakdaman R, Woodward PJ, Kennedy A. Complex Abdominal Wall Defects: Appearances at Prenatal Imaging. Radiographics 2015; 35:636-49. [DOI: 10.1148/rg.352140104] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Feigenbaum DF, Sybert VP, Vanderhooft SL, Siegel D, Drolet BA, Frieden IJ, Mathes EFD. Ventral midline blanching in the setting of segmental infantile hemangiomas: clinical observations and pathogenetic implications. Pediatr Dermatol 2015; 32:180-7. [PMID: 25529105 DOI: 10.1111/pde.12462] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Areas of blanched skin in children may be seen as an independent finding or in association with vascular birthmarks. We performed a retrospective chart review to identify and describe infants with areas of ventral midline blanching in the presence of segmental infantile hemangiomas. We identified nine full-term infants with partial or full segmental hemangiomas and areas of midline ventral blanching. Additional ventral wall defects were seen in five patients. Six had cardiac anomalies and six had intracranial anomalies. Five were diagnosed with definite PHACE (posterior fossa, hemangioma, arterial, cardiac, and eye abnormalities) syndrome and three had possible PHACE syndrome. Eight were complicated by ulceration. Treatment varied according to the case. Ventral blanching, even in the absence of overt midline defects, can be seen in infants with segmental hemangiomas at risk for PHACE syndrome. We hypothesize that midline blanching may represent a minor manifestation of a developmental ventral defect.
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Affiliation(s)
- Dana F Feigenbaum
- School of Medicine, University of California, San Diego, San Diego, California
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25
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Wertelecki W, Yevtushok L, Zymak-Zakutnia N, Wang B, Sosyniuk Z, Lapchenko S, Hobart HH. Blastopathies and microcephaly in a Chornobyl impacted region of Ukraine. Congenit Anom (Kyoto) 2014; 54:125-49. [PMID: 24666273 PMCID: PMC4233949 DOI: 10.1111/cga.12051] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2013] [Accepted: 01/05/2014] [Indexed: 12/17/2022]
Abstract
This population-based descriptive epidemiology study demonstrates that rates of conjoined twins, teratomas, neural tube defects, microcephaly, and microphthalmia in the Rivne province of Ukraine are among the highest in Europe. The province is 200 km distant from the Chornobyl site and its northern half, a region known as Polissia, is significantly polluted by ionizing radiation. The rates of neural tube defects, microcephaly and microphthalmia in Polissia are statistically significantly higher than in the rest of the province. A survey of at-birth head size showed that values were statistically smaller in males and females born in one Polissia county than among neonates born in the capital city. These observations provide clues for confirmatory and cause-effect prospective investigations. The strength of this study stems from a reliance on international standards prevalent in Europe and a decade-long population-based surveillance of congenital malformations in two distinct large populations. The limitations of this study, as those of other descriptive epidemiology investigations, is that identified cause-effect associations require further assessment by specific prospective investigations designed to address specific teratogenic factors.
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Affiliation(s)
- Wladimir Wertelecki
- Department of Medical Genetics, College of Medicine, University of South AlabamaMobile, Alabama, USA
- OMNI-Net for Children International Charitable FundRivne, Rivne Province, Ukraine
| | - Lyubov Yevtushok
- OMNI-Net for Children International Charitable FundRivne, Rivne Province, Ukraine
- Rivne Regional Medical Diagnostic CenterRivne, Rivne Province, Ukraine
| | - Natalia Zymak-Zakutnia
- OMNI-Net for Children International Charitable FundRivne, Rivne Province, Ukraine
- Khmelnytsky Perinatal CenterKhmelnytsky, Khmelnytsky Province, Ukraine
| | - Bin Wang
- Department of Mathematics and Statisitcs, University of South AlabamaMobile, Alabama, USA
| | - Zoriana Sosyniuk
- OMNI-Net for Children International Charitable FundRivne, Rivne Province, Ukraine
- Rivne Regional Medical Diagnostic CenterRivne, Rivne Province, Ukraine
| | - Serhiy Lapchenko
- OMNI-Net for Children International Charitable FundRivne, Rivne Province, Ukraine
| | - Holly H Hobart
- Cyto-Genetics Laboratory, Department of Pathology, University of Mississippi Medical CenterJackson, Mississippi, USA
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Surgical treatment and outcomes of pentalogy of Cantrell in eight patients. J Pediatr Surg 2014; 49:1335-40. [PMID: 25092102 DOI: 10.1016/j.jpedsurg.2014.06.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2014] [Revised: 06/04/2014] [Accepted: 06/09/2014] [Indexed: 11/22/2022]
Abstract
PURPOSE To summarize the experience and feasibility of radical one-stage surgical repair of pentalogy of Cantrell in eight cases in a single tertiary care center. PATIENTS AND METHODS From August, 2007 to June, 2011, eight patients with pentalogy of Cantrell were diagnosed. One of them had undergone intracardiac operation 2 years ago, leaving a large thoracoabdominal defect with most of the heart outside the chest. After correction of cardiac malformations, patients were individually treated with different operative procedures to restore their cardiac position and anatomy and repair their thoracoabdominal and diaphragmatic defects. RESULTS Surgical procedures in all the patients were uneventful. Seven cases underwent one-stage complete correction. The only patient candidate for second-stage operation underwent extended thoracoplasty because of inadequate accommodation for the heart. Diaphragmatic defects were repaired with a PROCEED patch in two cases and closed directly in the remainder. The right sixth and seventh ribs were grafted for chest reconstruction in two cases and the right seventh rib in one case. Chest wall clefts were closed directly in the remaining five cases. A left ventricular diverticulum was removed in one of the two patients. An interventricular residual shunt (0.5cm) was observed in one case and treated by transcatheter closure on the fifth day after operation. One case with double outlet right ventricle suffered from low cardiac output syndrome during the postoperative period and recovered after medical treatment. The early and midterm clinical outcomes were satisfactory without death or serious complications during the follow-up period of 24-72 months. CONCLUSION The diversity and complexity of POC result in a variable clinical course, with different clinical manifestations which require unique surgical procedures. Innovative multidisciplinary management strategies are necessary to achieve better outcomes. The key points in surgical treatment are: a) to obtain satisfactory correction of the cardiac malformation, b) adequate space for return of the heart to the mediastinum, and c) a thoracoabdominal wall repair which protects the heart from excessive compression or distortion. If treated correctly, most patients with less complex cardiac defects who survive the newborn period can be successfully treated via a one-stage operation.
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Prenatal Diagnosis of Cantrell's Pentalogy Associated with Agenesis of Left Limb in a Twin Pregnancy. Case Rep Obstet Gynecol 2014; 2014:314284. [PMID: 24782934 PMCID: PMC3981167 DOI: 10.1155/2014/314284] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2013] [Accepted: 02/12/2014] [Indexed: 11/17/2022] Open
Abstract
Pentalogy of Cantrell is a rare malformation described in the literature. We report a case of pentalogy of Cantrell associated with left limb deficiency in a twin pregnancy. The fetus with multiple anomalies revealed kyphosis, ectopia cordis, and a large defect with protruding liver and bowel loops at 12 weeks and 3 days of gestational age on ultrasound scan. The other fetus was ultrasonographically normal. We diagnosed a case of pentalogy of Cantrell in a twin pregnancy after exclusion of limb body wall complex, body stalk anomaly, and amniotic band syndrome and after delivery of the fetuses. Macroscopic examinations were ectopia cordis, extrusion of the abdominal organs without membranes surrounding, and agenesis of the left limb.
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Mallula KK, Sosnowski C, Awad S. Spectrum of Cantrell's pentalogy: case series from a single tertiary care center and review of the literature. Pediatr Cardiol 2013; 34:1703-10. [PMID: 23616208 DOI: 10.1007/s00246-013-0706-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2013] [Accepted: 04/04/2013] [Indexed: 11/27/2022]
Abstract
The pentalogy of Cantrell (PC) was first described in 1958. It includes five anomalies: a deficiency of the anterior diaphragm, a midline supraumbilical abdominal wall defect, a defect in the diaphragmatic pericardium, various congenital intracardiac abnormalities, and a defect of the lower sternum. Five patients showing the PC spectrum are reported. The report presents the prenatal diagnosis, the postnatal course, and the patients' outcome at a tertiary care center from June 2001 to May 2012. A literature review and the management plan for this group of patients also are discussed. All patient data were obtained via electronic medical records retrospectively after approval by the institutional review board at the home institution. The patients in the study were three males and two females. For all of the patients, a prenatal diagnosis had been determined. The mean gestational age at delivery was 36.6 weeks. One patient had associated cranial and spine malformations. All the patients had associated congenital heart disease but a normal karyotype. Four of the five patients died in the first year of life. The ages at death ranged from 0 to 259 days (mean, 46.2 ± 51.8 days). The patients who did not survive had withdrawal of care due to increased morbidity, associated complications, or parental wishes. The pentalogy of Cantrell is a wide spectrum of associations. Patients with the complete PC together with complex congenital heart disease or extracardiac malformations may have a poor prognosis. Incomplete PC cases may have a better outcome based on associated anomalies. Prenatal counseling plays a very important role in the decision-making process for the families and has a significant impact on the postnatal management. A multidisciplinary team approach is essential for successful postpartum outcomes.
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Affiliation(s)
- Kiran K Mallula
- Rush Center for Congenital and Structural Heart Disease, Rush University Medical Center, 1653 W. Congress Parkway, Chicago, IL, 60612, USA
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Pepper MA, Fishbein GA, Teitell MA. Thoracoabdominal wall defect with complete ectopia cordis and gastroschisis: a case report and review of the literature. Pediatr Dev Pathol 2013; 16:348-52. [PMID: 23688328 DOI: 10.2350/13-03-1318-cr.1] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Ventral wall defects are extremely rare anomalies that are likely caused by the failure of the ventral wall to close during week 4 of development. We report a case of severe thoracoabdominal wall defect including complete thoracic ectopia cordis and gastroschisis. This combination represents a novel constellation of findings in a single patient. This unique case further demonstrates an anatomically normal heart with age-appropriate development and an intact diaphragm. We review the literature of other reports and discussions of entities that share overlapping features with this case.
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Affiliation(s)
- Michael A Pepper
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine at UCLA, 10833 Le Conte Avenue, CHS 13-145, Los Angeles, CA 90095-1732, USA
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Abstract
Pentalogy of Cantrell is a rare congenital malformation whose exact cause is not completely understood; it is characterized by defects in the anterior abdominal and thoracic walls consisting of omphalocoele, diaphragmatic defect, ectopia cordis, intracardiac defects and sternal clefts. The complex has variable clinical expression with complete and incomplete expressions reported. We, therefore, report a case of complete manifestation of the pentad in a 9-month-old boy.
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Affiliation(s)
- Ibrahim Aliyu
- Department of Paediatrics, Aminu Kano Teaching Hospital/Bayero University, Kano, Nigeria
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Restrepo MS, Cerqua A, Turek JW. Pentalogy of Cantrell with Ectopia Cordis Totalis, Total Anomalous Pulmonary Venous Connection, and Tetralogy of Fallot: A Case Report and Review of the Literature. CONGENIT HEART DIS 2013; 9:E129-34. [DOI: 10.1111/chd.12101] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/29/2013] [Indexed: 11/28/2022]
Affiliation(s)
- M. Santiago Restrepo
- Department of Pediatrics; Division of Pediatric Cardiology; University of Iowa Children's Hospital-Carver College of Medicine; Iowa City Iowa USA
| | - Amanda Cerqua
- Perfusion Services; University of Iowa Children's Hospital-Carver College of Medicine; Iowa City Iowa USA
| | - Joseph W. Turek
- Department of Cardiothoracic Surgery; University of Iowa Children's Hospital-Carver College of Medicine; Iowa City Iowa USA
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McMahon CJ, Walsh KP. Transcatheter right ventricular outflow tract stent implantation in a child with pentalogy of cantrell, double outlet right ventricle, and severe pulmonary stenosis. Catheter Cardiovasc Interv 2013; 82:1164-7. [DOI: 10.1002/ccd.24852] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2012] [Revised: 12/20/2012] [Accepted: 01/27/2013] [Indexed: 11/11/2022]
Affiliation(s)
- Colin J. McMahon
- Department of Paediatric Cardiology; Our Lady's Children's Hospital; Crumlin Dublin 12 Ireland
| | - Kevin P. Walsh
- Department of Paediatric Cardiology; Our Lady's Children's Hospital; Crumlin Dublin 12 Ireland
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Di Spiezio Sardo A, Paladini D, Zizolfi B, Spinelli M, Nappi C. Pentalogy of Cantrell: embryofetoscopic diagnosis. J Minim Invasive Gynecol 2013; 20:248-51. [PMID: 23465262 DOI: 10.1016/j.jmig.2012.10.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2012] [Accepted: 10/20/2012] [Indexed: 11/28/2022]
Abstract
Embryofetoscopy is an endoscopic technique that permits a direct visualization and morphologic study of embryos during the first and early second trimester. We report the early prenatal diagnosis of a case of Pentalogy of Cantrell combining data obtained by 2-dimensional and 3-dimensional ultrasonography and embryofetoscopy. Morphologic examination focused on a large omphalocele protruding from the anterior abdominal wall as an oval pulsating mass, measuring approximately 3 cm. The visualization of an omphalocele with ectopia cordis without other malformations confirmed the diagnosis of Pentalogy of Cantrell (class III). Currently, embryofetoscopy allows direct visualization of the embryo in vivo, enabling accurate diagnosis of developmental defects and yielding additional insights into developmental disorders in the embryo.
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Affiliation(s)
- Attilio Di Spiezio Sardo
- Department of Obstetrics and Gynaecology and Pathophysiology of Reproduction, University of Naples "Federico II," Naples, Italy.
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Kinoshita M, Park S, Shiraishi T, Ueno S. Thoracoabdominoplasty with umbilicoplasty for Cantrell's syndrome. J Plast Surg Hand Surg 2012; 46:367-70. [PMID: 22931104 DOI: 10.3109/2000656x.2012.703464] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Cantrell et al. described a syndrome with five anomalies characterised by defects of the abdominal wall, lower sternum, anterior diaphragm, diaphragmatic pericardium, and heart. Because most of the children who survived could not have the thoracoabdominal wall adequately reconstructed at the initial operation, ventral herniation is often the result and they have to live with the danger of direct trauma to the unprotected heart. It therefore becomes important protect the unguarded heart while improving the appearance of the thoracoabdominal region. The reconstruction of the lower sternum has rarely been reported. We describe four such patients, three of whom had a thoracoabdominoplasty and umbilicoplasty using autologous rib cartilage and rectus muscles. All these children had solidly reconstructed sternums, and their abdominal appearances are excellent.
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Affiliation(s)
- Mikio Kinoshita
- Department of Plastic Surgery, Shizuoka Children's Hospital, Shizuoka, Japan.
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35
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Bellotti CA, Stewart RD, Golden AB, Mavroudis C, Vachhani N. Pentalogy of cantrell: surgical resection of a biventricular diverticulum. World J Pediatr Congenit Heart Surg 2012; 3:402-5. [PMID: 23804881 DOI: 10.1177/2150135111432353] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pentalogy of Cantrell is a rare diagnosis consisting of several midline defects of the sternum, abdominal wall, diaphragm, pericardium, and heart. One of the known features is ventricular diverticulum that can represent a technical challenge surgically. This is a follow-up case report of the successful simultaneous resection of a biventricular diverticulum and omphalocele repair after previous report of repair of complex intracardiac disease in the same patient.
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Affiliation(s)
- Christopher A Bellotti
- Pediatric and Congenital Heart Diseases, Pediatric and Congenital Cardiology, Cleveland Clinic Children's Hospital, Cleveland, OH, USA
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36
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Alguacil AF, Navarro PG, Benítez Linero I, Ontanilla López A. [Giant omphalocele correction in a patient with pentalogy of Cantrell]. ACTA ACUST UNITED AC 2012; 59:51-4. [PMID: 22429636 DOI: 10.1016/j.redar.2011.12.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2011] [Accepted: 12/15/2011] [Indexed: 11/19/2022]
Abstract
Pentalogy of Cantrell is a rare congenital malformation characterised by a large defect in the lower region of the sternum, diaphragm, and lower abdominal region. It is also characterised by the migration of organs, and its prognosis depends on the presence of cardiac malformations. We present the case of an 18 year-old male subjected to a scheduled giant omphalocele correction. Invasive monitoring, including cardiac output, was used to avoid episodes of instability due to the increase in abdominal pressure and the increase in venous return (as had happened on two previous operations). The prognosis depends on multiple factors, with good haemodynamic and respiratory control being the most important. Mortality is high despite the advances in monitoring.
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Moreira de Sá RA, de Souza Filho GPA, Lopes LM, Faleiro EC, Junior JA. Cantrell's Pentalogy in Twins: Prenatal Diagnosis. Twin Res Hum Genet 2012. [DOI: 10.1375/twin.9.4.597] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractThe combination of an onphalocele, an anterior thoracic wall defect and an anterior diaphragmatic defect constitutes classical Cantrell's pentalogy. We present a case of Cantrell's pentalogy diagnosed prenataly in twins with conventional and three-dimensional sonography.
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Brochut ACM, Baumann MU, Kuhn A, Di Naro E, Tutschek B, Surbek D, Raio L. Pentalogy or hexalogy of Cantrell? Pediatr Dev Pathol 2011; 14:396-401. [PMID: 21675879 DOI: 10.2350/10-09-0914-cc.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Pentalogy of Cantrell (PC) is a rare congenital syndrome involving the abdominal wall, sternum, diaphragm, pericardium, and heart. The embryonic period in which PC develops coincides with that of umbilical cord (UC) formation. The aim of the following study was to address the question of whether PC is associated with UC pathologies. Four cases, prenatally identified between 2002 and 2008, were enrolled in this study. Umbilical cord pathologies defined as single umbilical artery, short cord, or UC with atypical coiling pattern were retrospectively assessed on stored ultrasound images and from autopsy reports. The literature regarding PC and UC pathologies was reviewed. Three singleton pregnancies and 1 monoamniotic twin pregnancy with twin reversed arterial perfusion sequence were reviewed. All had a normal karyotype. Three showed the classical PC stigmata, with ectopia cordis. One fetus had no ectopia cordis; this case had a normal UC, whereas all others fetuses showed a short UC with atypical coiling pattern. Of 26 publications dealing with PC, the UC was described in only 8 cases, 7 of which were abnormal. There seems to be a strong correlation between the PC and UC abnormalities, in particular in cases with ectopia cordis. We speculate that the insult leading to the classical malformations of PC and UC abnormalities is the same or the sequence of malformations itself may alter the early fetoplacental blood flow and therefore the normal development of the UC angioarchitecture.
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Wen L, Jun-lin L, Jia H, Dong Z, Li-guang Z, Shu-hua D, Wei-jin L, Yun-hua G. Cantrell syndrome with complex cardiac malformations: a case report. J Pediatr Surg 2011; 46:1455-8. [PMID: 21763854 DOI: 10.1016/j.jpedsurg.2011.03.071] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Revised: 03/24/2011] [Accepted: 03/25/2011] [Indexed: 11/25/2022]
Abstract
Cantrell syndrome is a rare condition of congenital defects of 5 developmentally associated structures: the abdominal wall, sternum, diaphragm, pericardium, and heart. Few patients survive, and even fewer survive with good outcomes of quality of life. We present a case with the pentalogy and profound cardiac malformations. Despite repeated life-threatening conditions, the boy survived to have his first operation at 5 months old. The operation reduced the heart within the thoracoabdominal area, repaired the abdominal wall defect, and released multiple stenoses of the heart and great vessels. The patient recovered uneventfully. At 4.5 years old, he is healthy and developed normally.
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Affiliation(s)
- Li Wen
- Department of Radiology, XinQiao Hospital, Third Military Medical University, ChongQing 400037, PR China
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Santiago-Herrera R, Ramirez-Carmona R, Criales-Vera S, Calderon-Colmenero J, Kimura-Hayama E. Ectopia cordis with tetralogy of Fallot in an infant with pentalogy of Cantrell: high-pitch MDCT exam. Pediatr Radiol 2011; 41:925-9. [PMID: 21174085 DOI: 10.1007/s00247-010-1914-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2010] [Revised: 10/18/2010] [Accepted: 11/01/2010] [Indexed: 10/18/2022]
Abstract
We report the MDCT findings of a 17-month-old girl with Cantrell's pentalogy, a rare congenital disease characterized by several defects in the ventral thoracoabdominal wall including ectopia cordis, and, in this patient, associated with tetralogy of Fallot. This case provides an example of the utility of a wide volume in coverage and high-pitch MDCT scan in the evaluation of complex cardiovascular anatomy in infants with congenital heart disease without the need of an ECG-gating acquisition.
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Affiliation(s)
- Rogerio Santiago-Herrera
- Department of Radiology, Instituto Nacional de Cardiología Ignacio Chávez, Juan Badiano 1. Col. Sección XVI, Mexico City, Mexico.
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Balderrábano-Saucedo N, Vizcaíno-Alarcón A, Sandoval-Serrano E, Segura-Stanford B, Arévalo-Salas LA, de la Cruz LR, Espinosa-Islas G, Puga-Muñuzuri FJ. Pentalogy of Cantrell. World J Pediatr Congenit Heart Surg 2011; 2:211-8. [DOI: 10.1177/2150135110390528] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Pentalogy of Cantrell is a rare disease. Approximately 185 cases have been reported around the world. The authors performed a retrospective study that reviewed the clinical files and pathological samples of 22 cases of pentalogy of Cantrell treated at the Hospital Infantil de México Federico Gómez. Thirteen patients had ectopia cordis associated with pentalogy of Cantrell (group I), and there were 9 cases without ectopia cordis (group II). In group I, the following types of congenital heart disease were found: single ventricle (4), double-outlet right ventricle (4), ventricular septal defect (3), aortic coarctation (1), and atrial septal defect (1). In group II, the following types of congenital heart disease were found: double-outlet right ventricle (3), double-inlet left ventricle (2), ventricular septal defect (2), tetralogy of Fallot (1), and hypoplastic right ventricle syndrome (1). Nine cases had a ventricular diverticulum (40%). Ten patients (45%) had some other congenital anomaly associated with pentalogy of Cantrell. Thirteen patients underwent surgery (59%), which included cardiac surgery in 10 cases (45%). Sixteen patients died (73%): 11 from group I and 5 from group II ( P < .05). Little more than 50 years since it was first described, pentalogy of Cantrell remains a disease with high mortality, especially in patients with associated ectopia cordis.
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Affiliation(s)
| | | | | | | | - Luis A. Arévalo-Salas
- Departamento de Cardiología, Hospital Infantil de México Federico Gómez, México, D.F
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Smigiel R, Jakubiak A, Lombardi MP, Jaworski W, Slezak R, Patkowski D, Hennekam RC. Co-occurrence of severe Goltz-Gorlin syndrome and pentalogy of Cantrell - Case report and review of the literature. Am J Med Genet A 2011; 155A:1102-5. [PMID: 21484999 DOI: 10.1002/ajmg.a.33895] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2010] [Accepted: 12/17/2010] [Indexed: 11/11/2022]
Abstract
Goltz-Gorlin syndrome is a highly variable disorder affecting many body parts of meso-ectodermal origin. Mutations in X-linked PORCN have been identified in almost all patients with a classical Goltz-Gorlin phenotype. The pentalogy of Cantrell is an infrequently described congenital disorder characterized by the combination of five anomalies: a midline supra-umbilical abdominal wall defect; absent or cleft lower part of the sternum; deficiency of the diaphragmatic pericardium; deficiency of the anterior diaphragm; and congenital heart anomalies. Etiology and pathogenesis are unknown. We report on an infant with findings fitting both Goltz-Gorlin syndrome (sparse hair; anophthalmia; clefting; bifid nose; irregular vermillion of both lips; asymmetrical limb malformations; caudal appendage; linear aplastic skin defects; unilateral hearing loss) and the pentalogy of Cantrell (absent lower sternum; anterior diaphragmatic hernia; ectopia cordis; omphalocele). The clinical diagnosis Goltz-Gorlin syndrome was confirmed molecularly by a point mutation in PORCN (c.727C>T). The presence of molecularly confirmed Goltz-Gorlin syndrome and pentalogy of Cantrell in a single patient has been reported twice before. The present patient confirms that the pentalogy of Cantrell can be caused in some patients by a PORCN mutation. It remains at present uncertain whether this can be explained by the type or localization of the mutation within PORCN, or whether the co-occurrence of the two entities is additionally determined by mutations or polymorphisms in other genes, environmental factors, and/or epigenetic influences.
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Affiliation(s)
- Robert Smigiel
- Genetics Department, Wroclaw Medical University, Poland.
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Marino AL, Levy RJ, Berger JT, Donofrio MT. Pentalogy of Cantrell with a single-ventricle cardiac defect: collaborative management of a complex disease. Pediatr Cardiol 2011; 32:498-502. [PMID: 21210095 DOI: 10.1007/s00246-010-9867-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2010] [Accepted: 12/07/2010] [Indexed: 11/28/2022]
Abstract
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.
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Affiliation(s)
- Amy L Marino
- Division of Cardiology, Children's National Medical Center, Washington, DC, USA
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Atis A, Demirayak G, Saglam B, Aksoy F, Sen C. Craniorachischisis with a variant of pentalogy of Cantrell, with lung extrophy. Fetal Pediatr Pathol 2011; 30:431-6. [PMID: 21812640 DOI: 10.3109/15513815.2011.587500] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
A case of cranioraschischisis including incomplete pentalogy of Cantrell (PC) is described. The female fetus had a large omphalocele with evisceration of the heart, left lung, liver, stomach, and intestines accompanying anencephaly, cervical, thoracal lumbar, spina bifida. The fetus had ectopia cordis and diaphragmatic agenesia with an intact sternum. We present a case of a neonate with the stigmata for PC with the exception of a sternal defect. A literature review is also included. Sonographers should check for ventral and dorsal anomalies with PC because they may occur simultaneously.
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Affiliation(s)
- Alev Atis
- Sisli Etfal Training and Research Hospital, Istanbul, Turkey.
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Gün I, Kurdoğlu M, Müngen E, Muhcu M, Babacan A, Atay V. Prenatal diagnosis of vertebral deformities associated with pentalogy of Cantrell: the role of three-dimensional sonography? JOURNAL OF CLINICAL ULTRASOUND : JCU 2010; 38:446-449. [PMID: 20607852 DOI: 10.1002/jcu.20726] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Pentalogy of Cantrell was diagnosed in a fetus at 14 weeks of gestation, on routine two-dimensional sonographic examination with Doppler imaging, which revealed a midline supraumbilical abdominal wall defect including herniated liver, an ectopia cordis without intracardiac anomalies, and a large omphalocele containing intestines. Although left unilateral club foot deformity was also detected as an associated anomaly in the same examination, severe lumbar lordoscoliosis was only detected by using three-dimensional sonography because of the spatial configuration of the deformity. After termination of the pregnancy, postnatal inspection of the fetus confirmed the diagnosis of pentalogy of Cantrell associated with skeletal deformities and revealed low implant ears as an additional finding. Although two-dimensional sonography with Doppler imaging is sufficient to diagnose pentalogy of Cantrell, it may fail to show the complex vertebral deformities and three-dimensional sonography may assist in visualizing the defect accurately.
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Affiliation(s)
- Ismet Gün
- GATA Haydarpaşa Training Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey
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46
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Moon KY, Choe SA, Park CW, Park JS, Jun JK, Syn HC. Successful vaginal delivery of a pregnant woman with Cantrell's Pentalogy. J Korean Med Sci 2010; 25:1241-3. [PMID: 20676342 PMCID: PMC2908800 DOI: 10.3346/jkms.2010.25.8.1241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2009] [Accepted: 09/11/2009] [Indexed: 11/20/2022] Open
Abstract
Cantrell's Pentalogy is a rare condition that consists of defects involving the abdominal wall, lower sternum, anterior diaphragm, pericardium, and heart. In the literature to date, pregnant women with Cantrell's Pentalogy have not been discussed. We performed successful vaginal delivery of a 23-yr-old nulliparous, primigravid woman who had been diagnosed with this condition. Diagnosis was based on cardiac catheterization, angiography, and echocardiogram, and abdominopelvic CT. Vaginal delivery may be an option for women with Cantrell's Pentalogy and may be attempted with caution.
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Affiliation(s)
- Kyoung Yong Moon
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Seung Ah Choe
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Chan-Wook Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Joong Shin Park
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Jong Kwan Jun
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
| | - Hee Chul Syn
- Department of Obstetrics and Gynecology, Seoul National University College of Medicine, Seoul, Korea
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Chopra S, Kalpdev A, Suri V, Aggarwal N, Rohilla M. Complete ectopia cordis with anencephaly: a case report. JOURNAL OF CLINICAL ULTRASOUND : JCU 2010; 38:212-214. [PMID: 20232401 DOI: 10.1002/jcu.20667] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We report a case of pentalogy of Cantrell with anencephaly diagnosed in utero on 2-dimensional sonography at 17 weeks of gestation. Due to associated anencephaly, termination of pregnancy was carried out. Histopathological examination confirmed the sonographic findings.
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Affiliation(s)
- Seema Chopra
- Department of Obstetrics & Gynecology, Postgraduate Institute of Medical Education & Research (PGIMER), Sector-12, Chandigarh, India
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Suehiro K, Okutani R, Ogawa S, Nakada K, Shimaoka H, Ueda M, Shigemoto T. Perioperative management of a neonate with Cantrell syndrome. J Anesth 2009; 23:572-5. [PMID: 19921368 DOI: 10.1007/s00540-009-0785-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2008] [Accepted: 04/23/2009] [Indexed: 10/20/2022]
Abstract
Cantrell syndrome is a congenital malformation with a pentalogy characterized by defects involving the abdominal wall, lower sternum, anterior diaphragm, and diaphragmatic pericardium, as well as congenital cardiac anomalies. We recently managed anesthesia in a patient with this syndrome and herein report our experience. The patient was a 14-day-old male neonate, who had been diagnosed with Cantrell syndrome, including ventricular septal defect, left ventricular diverticulum, abdominal wall defect, omphalocele, and sternal hypoplasia. Surgical interventions to close the ventricular septal defect, resect the left ventricular diverticulum, and close the omphalocele were scheduled. After cardiac surgery, the hernial contents were returned to their original compartment and, subsequently, an attempt was made to suture the abdominal wall. However, blood pressure fell markedly and the attempt was discontinued. The chest was left open postoperatively and the patient was transferred to the intensive care unit (ICU), during which time circulatory and respiratory management was very complex. Issues requiring particular attention in the management of anesthesia for patients with this syndrome include complications of diverse cardiac malformations, pulmonary hypertension, pulmonary hypoplasia, and respiratory and circulatory failure associated with increased intraabdominal pressure due to primary closure of the omphalocele. Accordingly, extreme caution must be taken to restore respiratory and circulatory control.
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Affiliation(s)
- Koichi Suehiro
- Department of Anesthesiology and Pediatric Anesthesia, Osaka City General Hospital and Children Hospital, Miyakojimaku, Osaka, Japan
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Pete B, Hajdú J, Harmath A, Csapó Z, Papp C, Szigeti Z, Rigó J. [Pentalogy of Cantrell: six new cases]. Orv Hetil 2009; 150:2068-73. [PMID: 19861294 DOI: 10.1556/oh.2009.28744] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
UNLABELLED Cantrell's pentalogy is a rare multiple malformation syndrome consisting of supraumbilical abdominal wall defect, sternal defect, pericardial defect, anterior diaphragmatic defect and heart malformation. AIMS AND METHODS Prenatal ultrasound findings and malformations described during autopsy of the Cantrell's pentalogy cases diagnosed between January 1991 and June 2009 in our institute were reviewed. A literature research was conducted to analyze the prevalence and prenatal detection rate of the five previously described malformations and ectopia cordis in the Cantrell's pentalogy cases. RESULTS Six cases of Cantrell's pentalogy were diagnosed during the study period in our department. Sonography detected multiple malformations in 3 cases, and isolated malformation in 3 cases. Analyzing the data of 49 Cantrell's pentalogy cases altogether showed that, beside abdominal wall defect and ectopia cordis which had the highest prenatal detection rate (83% and 91% with a prevalence of 94% and 69%, respectively), sternal defect and anterior diaphragmatic hernia were also present in a large number of the cases (80% and 73% respectively). CONCLUSION Sonographic identification of the sternal defect or diaphragmatic hernia may help to differentiate Cantrell's pentalogy from malformations part of the syndrome but occurring as isolated defects.
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Affiliation(s)
- Barbara Pete
- Semmelweis Egyetem, Altalános Orvostudományi Kar I. Szülészeti és Nogyógyászati Klinika, Budapest.
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Murata S, Nakata M, Sumie M, Mastsuabra M, Sugino N. Prenatal Diagnosis of Pentalogy of Cantrell With Craniorachischisis by Three-Dimensionalultrasonography in the First Trimester. Taiwan J Obstet Gynecol 2009; 48:317-8. [DOI: 10.1016/s1028-4559(09)60315-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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