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Başar EZ, Dogan Y, Kayabey Ö, Babaoğlu K. Evaluation of clinical features and outcome of eight fetuses with ectopia cordis; A study from a fetal cardiology center. Congenit Anom (Kyoto) 2023; 63:66-73. [PMID: 36680738 DOI: 10.1111/cga.12508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 01/10/2023] [Accepted: 01/11/2023] [Indexed: 01/22/2023]
Abstract
We aim to evaluate the clinical course and outcome of cases with a prenatal diagnosis of ectopia cordis in our center. In this retrospective study, we analyzed clinical variables including gestational age at diagnosis, maternal age, associated cardiac, extracardiac, genetic anomalies and, outcome in prenatally diagnosed ectopia cordis cases in our tertiary referral center. Eight ectopia cordis cases from seven pregnancies were included in the study. All fetuses had complete type of ectopia cordis and pentalogy of Cantrell. Five multiple pregnancies were found, four were twin pregnancies (three dichorionic diamniotic, one monochorionic monoamniotic) and one was triplet (trichorionic triamniotic). In the monochorionic monoamniotic twin pregnancy, both fetuses have pentalogy of Cantrell. Two cases had intracardiac structural defects including Tetralogy of Fallot and hypoplastic right heart syndrome. Three pregnancies were terminated, four cases delivered alive could not survive beyond the neonatal period. The striking feature in our study is its association with multiple pregnancies.
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Affiliation(s)
- Eviç Zeynep Başar
- Department of Pediatric Cardiology, School of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Yasemin Dogan
- Department of Perinatology, School of Medicine, Kocaeli University, Kocaeli, Turkey
| | - Özlem Kayabey
- Department of Pediatric Cardiology, Mersin City Training and Research Hospital, Mersin, Turkey
| | - Kadir Babaoğlu
- Department of Pediatric Cardiology, School of Medicine, Kocaeli University, Kocaeli, Turkey
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Ugas-Charcape CF, Cerrón Vela C, Melgar Humala E, Herrera Taquia R, Caro Domínguez P. Computed tomography angiography features of children with ectopia cordis. Pediatr Radiol 2022; 53:1019-1026. [PMID: 36585499 DOI: 10.1007/s00247-022-05571-9] [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] [Received: 05/10/2022] [Revised: 11/20/2022] [Accepted: 12/14/2022] [Indexed: 01/01/2023]
Abstract
Ectopia cordis is a rare congenital defect with high mortality, and it remains challenging to radiologists, neonatologists and surgeons. CT angiography provides key information that aids in the decision-making process for possible surgical intervention. This pictorial essay describes CT angiography features in six neonates with ectopia cordis.
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Affiliation(s)
- Carlos F Ugas-Charcape
- Department of Diagnostic Imaging, Instituto Nacional de Salud del Niño San Borja, Av. Javier Prado Este 3101, Lima, 15037, Peru.
| | - Carmen Cerrón Vela
- Department of Diagnostic Imaging, Instituto Nacional de Salud del Niño San Borja, Av. Javier Prado Este 3101, Lima, 15037, Peru
| | - Eneida Melgar Humala
- Department of Cardiovascular Surgery, Instituto Nacional de Salud del Niño San Borja, Lima, Peru
| | - Renée Herrera Taquia
- Service of Tissue Bank, Instituto Nacional de Salud del Niño San Borja, Lima, Peru
| | - Pablo Caro Domínguez
- Unidad de Radiología Pediátrica, Servicio de Radiología, Hospital Universitario Virgen del Rocío, Sevilla, Spain
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Pentalogy of Cantrell With a Maxillary Gap Identified at 12 Weeks of Gestation. JOURNAL OF DIAGNOSTIC MEDICAL SONOGRAPHY 2022. [DOI: 10.1177/87564793221123073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pentalogy of Cantrell (POC) is a rare syndrome, with an omphalocele and ectopia cordis (EC) being pathognomonic anomalies. In this case report, a 12-week fetus, for nuchal translucency (NT) assessment, displayed a sac protruding through the midline of the fetal abdomen and lower thorax. The fetus’ cardiac activity was detected within the sac. These sonographic appearances are consistent with omphalocele and EC, respectively. A thickened NT and cystic hygroma (CH) were also identified. An important finding was a 1.8 mm maxillary gap (MG), which is a new marker for possible early diagnosis of cleft lip and palate (CLP), in the first trimester. The coexistence of a MG with POC is unique.
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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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Fazea M, Alhameli M, Ahmed F, Askarpour MR, Murshed W, Jarwsh A, Alkbous A. Pentalogy of Cantrell Associated with Ectopia Cordis: A Case Report. Pediatric Health Med Ther 2022; 13:283-287. [PMID: 35996555 PMCID: PMC9391988 DOI: 10.2147/phmt.s374289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2022] [Accepted: 08/10/2022] [Indexed: 11/23/2022] Open
Abstract
Pentalogy of Cantrell is a congenital anomaly of the median mesodermal constructions with a poor prognosis. It is characterized by defects of the anterior diaphragm, the lower sternum, the abdominal wall, pericardium, and various congenital heart malformations. We present a case of ectopia cordis and Pentalogy of Cantrell in a newborn of a healthy 35-year-old woman with no history of embryotoxic exposure or smoking. The infant was first diagnosed with the anomaly in the second trimester of pregnancy and was delivered at 35 weeks of gestational age via a caesarian section. Shortly after birth, he was transferred to the neonatal intensive care unit (NICU) due to progressive respiratory failure, which ultimately, along with septicemia, led to infant death on the second day. In conclusion, the Pentalogy of Cantrell should be appropriately assessed for effective prenatal counseling and postnatal management with a multidisciplinary team; since infant survival assessment and early diagnosis give the parents the option of terminating the pregnancy.
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Affiliation(s)
- Muneer Fazea
- Department of Radiology, School of Medicine, Ibb University of Medical Sciences, Ibb, Yemen.,Department of Radiology, Al-Ma'amon Diagnostic Center, Sana'a, Yemen
| | - Mansour Alhameli
- Department of Radiology, Al-Ma'amon Diagnostic Center, Sana'a, Yemen.,Department of Radiology, Faculty of Medicine, Sana'a University of Medical Sciences, Sana'a, Yemen
| | - Faisal Ahmed
- Urology Research Center, Al-Thora General Hospital, Department of Urology, School of Medicine, Ibb University of Medical Sciences, Ibb, Yemen
| | - Mohammad Reza Askarpour
- Department of Urology, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Wafa Murshed
- Department of Radiology, Al-Ma'amon Diagnostic Center, Sana'a, Yemen
| | - Azizh Jarwsh
- Department of Radiology, Al-Ma'amon Diagnostic Center, Sana'a, Yemen
| | - Amal Alkbous
- Department of Radiology, Al-Ma'amon Diagnostic Center, Sana'a, Yemen
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Kahveci B, Melekoglu R, Deger U, Demir SC. Prenatal diagnosis of a rare isolated thoracic-type ectopia cordis with complete form: a case report. J Ultrasound 2022; 25:305-308. [DOI: 10.1007/s40477-020-00496-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/12/2020] [Indexed: 11/27/2022] Open
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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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Wang D, Zheng B, Zhai B, Mo J, Yang K, Huo Y. Clinical and ultrasound findings of pentalogy of Cantrell in a newborn: A case report. Front Pediatr 2022; 10:998495. [PMID: 36458139 PMCID: PMC9705726 DOI: 10.3389/fped.2022.998495] [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] [Received: 07/20/2022] [Accepted: 10/19/2022] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Pentalogy of Cantrell is a rare and deadly syndrome, manifesting as intracardiac anomalies and ventricular diverticulum. Echocardiographers have an insufficient understanding of pentalogy of Cantrell, which may lead to missed diagnoses, especially in cases lacking the most obvious signs. CASE SUMMARY One of twin male infants, at a gestational age of 37 weeks, was found with a cardiac murmur and a pulsatile mass in the midline supraumbilical abdomen for 2 days. Echocardiography on admission indicated congenital heart disease. A cardiac murmur was detected in the 3-4 intercostal space and extensively spread. The infant was diagnosed with pentalogy of Cantrell by ultrasound and computed tomography angiography (CTA) preoperatively. The patient underwent heart deformity surgery and was followed up for 16 months. The patient's cardiac structure and function returned to normal. CONCLUSION Intracardiac anomaly and ventricular diverticulum are the primary manifestations of pentalogy of Cantrell. Pentalogy of Cantrell may be diagnosed by combining the ultrasound and CTA findings.
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Affiliation(s)
- Dan Wang
- Department of Ultrasound, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, ZhengZhou China
| | - Bin Zheng
- Department of Radiology, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, ZhengZhou China
| | - Bo Zhai
- Department of Cardiothoracic Surgery, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, ZhengZhou China
| | - Juan Mo
- Department of Ultrasound, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, ZhengZhou China
| | - Kaihua Yang
- Department of Radiology, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, ZhengZhou China
| | - Yaling Huo
- Department of Ultrasound, Children's Hospital Affiliated to Zhengzhou University, Henan Children's Hospital, Zhengzhou Children's Hospital, ZhengZhou China
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Zvizdic Z, Sefic-Pasic I, Mesic A, Terzic S, Vranic S. The complete spectrum of pentalogy of Cantrell in one of a set of dizygotic twins: A case report of a rare congenital anomaly. Medicine (Baltimore) 2021; 100:e25470. [PMID: 33832161 PMCID: PMC8036021 DOI: 10.1097/md.0000000000025470] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 03/18/2021] [Indexed: 01/05/2023] Open
Abstract
RATIONALE Pentalogy of Cantrell (POC) is an extremely rare syndrome with an estimated incidence of 1:65,000 to 200,000 live births. Its complete form includes a midline epigastric abdominal wall defect, defects affecting the lower sternum, anterior diaphragm, diaphragmatic pericardium, and various intracardiac defects. PATIENT CONCERNS We report a case of complete POC affecting only the first-born of a set of premature dizygotic twins. DIAGNOSIS A giant omphalocele with an eviscerated liver and bowel on prenatal, obstetric ultrasonography at 24 gestational weeks was observed. At birth, physical examination confirmed a massive (10 × 8 cm) epigastric omphalocele in which a significant part of the liver was seen. A postnatal echocardiogram revealed the presence of an ostium secundum atrial septal defect, perimembranous ventricular septal defect, and moderate pulmonary stenosis. X-ray showed an abnormal intrathoracic positioned stomach, which was confirmed with a plain x-ray of the upper intestinal tract with hydrosoluble contrast. Computed tomography (CT) scan revealed the sternum's absence and a close connection between the pericardial sac and the stomach wall. INTERVENTIONS The patient underwent surgical intervention at 18 days of age. OUTCOMES Despite adequate and appropriate postoperative treatment, the baby rapidly deteriorated and died 72 hours after surgery. LESSONS POC is a complex, high-mortality syndrome whose management requires a multidisciplinary approach and meticulous planning. Despite all efforts, POC carries a poor prognosis, particularly in patients affected by its complete form.
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Affiliation(s)
| | | | - Amira Mesic
- Department of Anesthesiology and Reanimation
| | - Sabina Terzic
- Pediatric Clinic, University Clinical Center Sarajevo, Sarajevo, Bosnia and Herzegovina
| | - Semir Vranic
- College of Medicine
- Biomedical and Pharmaceutical Research Unit, Qatar University Health, Qatar University, Doha, Qatar
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Demir M, Sertel E, Ture MZ. Twin pregnancy in which both fetuses have Cantrell's pentalogy: A case report and literature review. Eur J Obstet Gynecol Reprod Biol 2021; 260:64-69. [PMID: 33743359 DOI: 10.1016/j.ejogrb.2021.03.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2020] [Revised: 02/03/2021] [Accepted: 03/04/2021] [Indexed: 10/21/2022]
Abstract
Cantrell's pentalogy is a congenital multiple malformation consisting of midline supraumbilical thoraco-abdominal wall defects, anterior and pericardial diaphragm defects, lower sternum defects, ectopia cordis and various intracardiac anomalies. Complete pentalogy is very rare. Some additional anomalies may accompany pentalogy and there are cases in the literature where chromosomal anomalies and pentalogy are seen. Cases of Cantrell's pentalogy in twin pregnancies are rare. Twin pregnancies with Cantrell's pentalogy in both fetuses are one of the rarest cases in the literature. In this study, we presented a twin pregnancy case with Cantrell's pentalogy in both fetuses and we reviewed twin pregnancy cases in which Cantrell's pentalogy was seen in the literature. In our case, anomalies were found in both fetuses in the evaluation performed on a 32-year-old, gravida 2, para 1 woman with 10 weeks + 5 days monochorionic-monoamniotic twin pregnancy. The first fetus had ectopia cordis, cystic hygroma and increased nuchal thickness (4.6 mm), and the anterior abdominal wall was in contact with the amniotic band. The second fetus had ectopia cordis omphalocele, cystic hygroma, holoprosencephaly and a single lower extremity deficiency. Both fetuses were pre-diagnosed with Cantrell's pentalogy and the parents were informed about the adverse course of the fetuses. After the completion of the legal procedures, with the approval and decision of the parents, termination was made in the 11th week of pregnancy. External images of the fetuses confirmed the diagnosis. The family denied the autopsy procedure. When we review the literature, twin pregnancies complicated by Cantrell's pentalogy are divided into 3 groups: Group1- cases where one of the twins has completely normal phenotype and the other twin has Cantrell's pentalogy; Group2- cases where one of the twins has Cantrell's pentalogy and the other twin does not have the Cantrell's pentalogy but has several anomalies; Group3- cases where both fetuses have Cantrell's pentalogy. In conclusion, early diagnosis of twin pregnancy cases complicated by Cantrell's pentalogy and determination of all anomalies in both fetuses are very important in terms of obstetric management.
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Affiliation(s)
- Merve Demir
- Department of Obstetrics and Gynecology, Erzin State Hospital, Hatay, Turkey.
| | - Emre Sertel
- Department of Obstetrics and Gynecology, Gebze Fatih State Hospital, Kocaeli, Turkey
| | - Mehmet Zeki Ture
- Department of Obstetrics and Gynecology, Kocaeli University Faculty of Medicine, Kocaeli, Turkey
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Samaniego Haro V. Pentalogía de Cantrell. Reporte de un caso en el Hospital San Vicente de Paúl de Ibarra, Ecuador. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2021. [DOI: 10.1016/j.gine.2020.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Williams P, Booth M, Rossanese M. Incomplete pentalogy of Cantrell in a Border terrier puppy. VETERINARY RECORD CASE REPORTS 2020. [DOI: 10.1136/vetreccr-2020-001188] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Phillipa Williams
- Small Animal Teaching HospitalUniversity of LiverpoolNestonCheshireUK
| | - Malcolm Booth
- Small Animal Teaching HospitalUniversity of LiverpoolNestonCheshireUK
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Semionov A, Kosiuk J, Ajlan A, Discepola F. Imaging of Thoracic Wall Abnormalities. Korean J Radiol 2020; 20:1441-1453. [PMID: 31544369 PMCID: PMC6757005 DOI: 10.3348/kjr.2019.0181] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Accepted: 06/10/2019] [Indexed: 01/12/2023] Open
Affiliation(s)
- Alexandre Semionov
- Department of Diagnostic Radiology, McGill University Health Centre, Montreal General Hospital, Montreal, Canada.
| | - John Kosiuk
- Department of Diagnostic Radiology, McGill University Health Centre, Montreal, Canada
| | - Amr Ajlan
- Department of Radiology, King Abdulaziz University, Faculty of Medicine, Jeddah, Saudi Arabia
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Schiavone M, Pizzol D, Colangelo AC, Antunes M. Conservative management of Cantrell syndrome: a case report. J Surg Case Rep 2020; 2020:rjaa100. [PMID: 32509265 PMCID: PMC7263755 DOI: 10.1093/jscr/rjaa100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2020] [Revised: 03/27/2020] [Accepted: 03/28/2020] [Indexed: 11/13/2022] Open
Abstract
Cantrell syndrome (CS) is defined as congenital combination of five anomalies: defects at the lower part of the sternum, anterior diaphragm, midline supraumbilical abdominal wall, diaphragmatic pericardium and ectopia cordis. Antenatal screening should be performed to make an accurate prenatal diagnosis. The prognosis is usually poor with a high mortality early in life. The gold standard management is surgery but its prognosis remains poor. In many low-income settings prenatal examinations and surgery treatment are not possible. In the present case, we report a not surgery managed baby affected by CS, with good clinical conditions after 5 months.
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Affiliation(s)
- Marcella Schiavone
- Department of Emergency and Organ Transplantation-Section of Thoracic Surgery, University of Bari, Bari, Italy
| | - Damiano Pizzol
- Italian Agency for Development Cooperation, Khartoum, Sudan
| | | | - Mario Antunes
- Department of Surgery, Central Hospital of Beira, Beira, Mozambique
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Srinivasakumar P, Rama G, Jesse N, Howell RG, Brady JL, Morales TT, Maramreddy H, Hogan J, Cosper GH, Schmelzer T, Bambini DA, Schulman A, Kothadia J. First reported case of Pentalogy of Cantrell variant with good outcome in a 32 week gestational age monozygotic twin with twin-twin transfusion syndrome. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2019. [DOI: 10.1016/j.epsc.2019.101321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
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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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Asai H, Shingu Y, Ito N, Tachibana T. Norwood Operation of a Neonate With Pentalogy of Cantrell. Ann Thorac Surg 2019; 109:e135-e136. [PMID: 31238028 DOI: 10.1016/j.athoracsur.2019.04.110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 04/25/2019] [Accepted: 04/26/2019] [Indexed: 11/26/2022]
Abstract
Surgical correction of Cantrell syndrome is often associated with an extremely high mortality rate due to the possibility of wound infection or the severity of cardiac anomalies. We report a case of Norwood operation and repositioning of the heart successfully performed 1 day after the birth of a neonate with pentalogy of Cantrell. The patient had double-outlet right ventricle, subaortic stenosis, aortic valve stenosis, hypoplastic aortic arch, and coarctation of the aorta. The patient underwent the Glenn operation at the age of 1 year and is now waiting for the Fontan operation.
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Affiliation(s)
- Hidetsugu Asai
- Department of Cardiovascular Surgery, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Yasushige Shingu
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan.
| | - Nagomi Ito
- Department of Cardiovascular and Thoracic Surgery, Faculty of Medicine and Graduate School of Medicine, Hokkaido University, Sapporo, Japan
| | - Tsuyoshi Tachibana
- Department of Cardiovascular Surgery, Kanagawa Children's Medical Center, Yokohama, Japan
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Abstract
Pentalogy of Cantrell is a constellation of five congenital defects that pose a unique challenge for surgeons. Defects of the heart, pericardium, diaphragm, sternum, and anterior abdominal wall are pathognomonic. Although the incidence is low, it is critical to identify it in a timely fashion in order to adequately address all aspects. Early diagnosis, supportive care, and strategic surgical planning with a multidisciplinary team are all key components in managing patients with Pentalogy of Cantrell. In this text we sought to explore the evolution of both the understanding and treatment for this complex entity and provide current recommendations to today's pediatric caregivers.
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Türkyilmaz G, Avcı S, Sıvrıkoz T, Erturk E, Altunoglu U, Turkyilmazlmaz SE, Kalelioglu IH, Has R, Yuksel A. Prenatal Diagnosis and Management of Ectopia Cordis: Varied Presentation Spectrum. Fetal Pediatr Pathol 2019; 38:127-137. [PMID: 30600745 DOI: 10.1080/15513815.2018.1556367] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Ectopia cordis (EC) is a congenital anomaly associated with heart defects and extracardiac malformations. OBJECTIVES We determined the various presentations of EC diagnosed in our center between 2010 and 2017. RESULTS Seven fetuses from six pregnancies with EC were detected, five during the first trimester. Three were from multiple pregnancies, and both twins had EC in one monochorionic-monoamniotic pregnancy. Abdominal wall defects were detected in six fetuses. Kyphoscoliosis, cephalocele, clubfoot and short umbilical cord were other abnormalities. Five fetuses were terminated, one fetus died in utero, and one baby died on day two of life. Postnatal evaluation performed in all cases additionally detected cleft lips/palates in two fetuses and tetralogy of Fallot in one. CONCLUSION Outcome is poor for these fetuses, EC can occur in a multiple pregnancy, most of the abnormalities can be identified in the first trimester and fetopsy continues to add information to the intrauterine diagnosis.
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Affiliation(s)
- Gürcan Türkyilmaz
- a Department of Obstetrics and Gynecology, Istanbul Faculty of Medicine , Istanbul University , Istanbul , Turkey
| | - Sahin Avcı
- b Department of Medical Genetics , Istanbul Faculty of Medicine, Istanbul University , Istanbul , Turkey
| | - Tugba Sıvrıkoz
- a Department of Obstetrics and Gynecology, Istanbul Faculty of Medicine , Istanbul University , Istanbul , Turkey
| | - Emircan Erturk
- a Department of Obstetrics and Gynecology, Istanbul Faculty of Medicine , Istanbul University , Istanbul , Turkey
| | - Umut Altunoglu
- b Department of Medical Genetics , Istanbul Faculty of Medicine, Istanbul University , Istanbul , Turkey
| | | | - Ibrahim Halil Kalelioglu
- a Department of Obstetrics and Gynecology, Istanbul Faculty of Medicine , Istanbul University , Istanbul , Turkey
| | - Recep Has
- a Department of Obstetrics and Gynecology, Istanbul Faculty of Medicine , Istanbul University , Istanbul , Turkey
| | - Atil Yuksel
- a Department of Obstetrics and Gynecology, Istanbul Faculty of Medicine , Istanbul University , Istanbul , Turkey
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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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Mărginean C, Mărginean CO, Gozar L, Meliţ LE, Suciu H, Gozar H, Crişan A, Cucerea M. Cantrell Syndrome-A Rare Complex Congenital Anomaly: A Case Report and Literature Review. Front Pediatr 2018; 6:201. [PMID: 30065917 PMCID: PMC6056637 DOI: 10.3389/fped.2018.00201] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2018] [Accepted: 06/27/2018] [Indexed: 01/03/2023] Open
Abstract
Cantrell syndrome (CS) or pentalogy of Cantrell is defined as a rare condition involving a midline anterior abdominal wall defect, a distal sternal cleft, a defect of the anterior diaphragm, and a defect of the apical pericardium with pericardio-peritoneal communication, as well as intracardiac anomalies. We report the case of a male newborn with type 2 CS diagnosed during intrauterine life based on ultrasonographic evaluation. Clinical examination at birth revealed an abdominal wall defect with extrathoracic displacement of the heart and a diastasis of the sagittal suture. Postnatal echocardiography revealed tricuspid atresia, partial extrathoracic and extra-abdominal displacement of the heart and liver, a large ventricular septal defect, severe subpulmonary stenosis, hypoplasia of the pulmonary artery, and a large hourglass-shaped left ventricle secondary to narrowing of the heart at the level of its extrathoracic displacement. Computed tomography showed additional abnormalities including increased left ventricular volume with extrathoracic apical aneurysmal dilatation below the xiphoid process at the level of anterior abdominal wall, a hypoplastic right ventricle, partial transparietal herniation of the left hepatic lobe adjacent to a left ventricular diverticulum, and an adrenal hematoma. The newborn received intensive medical management during his first week of life; however, surgical management had to be postponed owing to his unstable condition. Eventually, it was performed on the 14th day of life, but unfortunately, the newborn died shortly after the procedure.
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Affiliation(s)
- Claudiu Mărginean
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy Tîrgu Mureş, Tîrgu Mureş, Romania
| | - Cristina Oana Mărginean
- Department of Pediatrics, University of Medicine and Pharmacy Tîrgu Mures, Tîrgu Mures, Romania
| | - Liliana Gozar
- Department of Pediatric Cardiology, University of Medicine and Pharmacy Tîrgu Mures, Tîrgu Mures, Romania
| | - Lorena Elena Meliţ
- Department of Pediatrics, University of Medicine and Pharmacy Tîrgu Mures, Tîrgu Mures, Romania
| | - Horaţiu Suciu
- Department of Cardiovascular Surgery, University of Medicine and Pharmacy Tîrgu Mures, Tîrgu Mures, Romania
| | - Horea Gozar
- Department of Pediatric Surgery, University of Medicine and Pharmacy Tîrgu Mures, Tîrgu Mures, Romania
| | - Andrada Crişan
- Department of Obstetrics and Gynecology, University of Medicine and Pharmacy Tîrgu Mureş, Tîrgu Mureş, Romania
| | - Manuela Cucerea
- Department of Neonatology, University of Medicine and Pharmacy Tîrgu Mureş, Tîrgu Mureş, Romania
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Masoom SHF, Dalouee MN, Abrahimzadeh M, Rajai Z. Evaluation of the results of surgery treatment in patients with congenital chest deformity. Indian J Thorac Cardiovasc Surg 2018. [DOI: 10.1007/s12055-017-0491-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Abstract
Background Ectopia Cordis is defined as complete or partial displacement of the heart outside the thoracic cavity. It is a rare congenital defect with failure of fusion of the sternum with extra thoracic location of the heart. The estimated prevalence of this case is 5.5 to 7.9 per million live births. Case Presentation We had a case of a 16-hour-old male neonate weighing 2.9kg with externally visible, beating heart over the chest wall. Initial treatment included covering the heart with sterile-saline soaked dressing, starting systemic antibiotics and supportive care. A staged surgical approach to this defect with the initial aim of replacement of the heart to the thoracic cavity was opted. The neonate died twenty minutes after the surgical intervention due to cardiogenic shock despite adequate resuscitative measures. Conclusion This case report underscores the missed opportunity of antenatal ultra-sonographic diagnosis and the challenge of Ectopia Cordis treatment in Ethiopia.
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Affiliation(s)
- Henok Tadele
- Department of Pediatrics and Child Health, Hawasa University, Ethiopia
| | - Abeje Chanie
- Department of Surgery, Hawasa University, Ethiopia
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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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One-stage surgical treatment for Cantrell syndrome without repairing the left ventricular diverticulum: a case report. Cardiol Young 2016; 26:191-3. [PMID: 25880315 DOI: 10.1017/s104795111500030x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Cantrell syndrome includes the defects of the heart, pericardium, diaphragm, abdominal wall, and sternum. The operative mortality is usually high. We report here a one-stage surgical correction in a case of Cantrell syndrome with left ventricular diverticulum.
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Madžarac V, Matijević R, Škrtić A, Duić Ž, Fistonić N, Partl JZ. Pentalogy of Cantrell with Unilateral Kidney Evisceration: A Case Report and Review of Literature. Fetal Pediatr Pathol 2016; 35:43-9. [PMID: 26720496 DOI: 10.3109/15513815.2015.1122123] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Pentalogy of Cantrell (PC) is a congenital malformation syndrome characterized by midline thoracoabdominal wall defect resulting from defective development in the septum transversum. Major hallmarks of this rare anomaly are omphalocele and ectopic heart. In most cases, the diagnosis is made by two-dimensional ultrasound in second trimester. The prognosis of PC relies on the presence and severity of cardiac anomalies but in most cases outcome is fatal. To the best of our knowledge, the presence of kidneys into the omphalocele in Cantrells' pentalogy has not been reported yet. In this article, we report a case of PC associated with unilateral kidney evisceration.
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Affiliation(s)
| | | | - Anita Škrtić
- b University Department of Pathology , University Hospital Merkur , Zagreb , Croatia
| | - Željko Duić
- a University Department of Obstetrics and Gynecology
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Lack V, Oetzmann von Sochaczewski C, Naidoo K, Loveland J. Pentalogy of Cantrell with thoracoabdominal ectopia cordis: Attempted surgical correction and review of recent literature to aid prognostication prior to surgery. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2015. [DOI: 10.1016/j.epsc.2015.09.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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Coincidence of Incomplete Pentalogy of Cantrell and Meningomyelocele in a Dizygotic Twin Pregnancy. Case Rep Obstet Gynecol 2015; 2015:629561. [PMID: 26421202 PMCID: PMC4569782 DOI: 10.1155/2015/629561] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2015] [Accepted: 08/25/2015] [Indexed: 12/04/2022] Open
Abstract
Pentalogy of Cantrell is an extremely rare and lethal syndrome. Ectopia cordis is frequently found in fetuses with POC but not required for incomplete forms. Likewise, meningomyelocele is a relatively uncommon neural tube defect affecting central nervous system and associated with neurological problems. Herein, we presented a woman with dizygotic twin pregnancy having coincidence of incomplete POC and MMC in each individual fetus, which has never been reported previously.
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Błaszczyński M, Kurzawa P, Becela P, Westerski P, Mościcka A, Khaneki S, Studniarek A, Mańkowski P. Pentalogy of Cantrell: Complete expression with mediastinal teratoma. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2015. [DOI: 10.1016/j.epsc.2015.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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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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Benlloch-Gonzalez M, Poncet C. Sternal Cleft Associated with Cantrell's Pentalogy in a German Shepherd Dog. J Am Anim Hosp Assoc 2015; 51:279-84. [PMID: 26083439 DOI: 10.5326/jaaha-ms-6181] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
A 5 mo old male German shepherd dog weighing 15.5 kg was presented with an abdominal wall hernia and exercise intolerance. Physical examination showed a grade II/VI systolic heart murmur and an area of cutaneous atrophy overlying a midline supraumbilical wall defect. Thoracic radiography, computed tomography, and ultrasound examination revealed a congenital caudal sternal cleft, a supraumbilical diastasis rectus, and a patent ductus arteriosus. Exploratory surgery confirmed defects of the pars sternalis of the diaphragm and caudoventral pericardium and a persistent left cranial vena cava. Those findings were compatible with Cantrell's pentalogy. Surgical treatment included ligation of the patent ductus arteriosus through the sternal cleft, diaphragmatic reconstruction with paracostal extension of the diaphragmatic defect, pericardial and linea alba appositional reconstruction, and primary approximation of the sternal halves. Growth and exercise activity were normal 10 mo after surgery. The discovery of a midline cranial abdominal wall, pericardial, diaphragmatic, or sternal defect should prompt a thorough examination to rule out any possible associated syndrome. Cantrell's pentalogy presents various degrees of expression and is rare in dogs. Management involves early surgical repair of congenital anomalies to protect the visceral structures. The prognosis in dogs with mild forms of the syndrome is encouraging.
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Zucker EJ, Epelman M, Newman B. Perinatal Thoracic Mass Lesions: Pre- and Postnatal Imaging. Semin Ultrasound CT MR 2015; 36:501-21. [PMID: 26614133 DOI: 10.1053/j.sult.2015.05.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Chest masses present a common problem in the perinatal period. Advances in prenatal ultrasound, supplemented by fetal magnetic resonance imaging, now allow early detection and detailed characterization of many thoracic lesions in utero. As such, in asymptomatic infants, assessment with postnatal computed tomography or magnetic resonance imaging can often be delayed for several months until the time at which surgery is being contemplated. Bronchopulmonary malformations comprise most of the thoracic masses encountered in clinical practice. However, a variety of other pathologies can mimic their appearances or produce similar effects such as hypoplasia of a lung or both lungs. Understanding of the key differentiating clinical and imaging features can assist in optimizing prognostication and timely management.
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Affiliation(s)
- Evan J Zucker
- Department of Radiology, Stanford University School of Medicine, Lucile Packard Children's Hospital, Stanford, CA.
| | - Monica Epelman
- Department of Medical Imaging, Nemours Children's Hospital, Orlando, FL
| | - Beverley Newman
- Department of Radiology, Stanford University School of Medicine, Lucile Packard Children's Hospital, Stanford, CA
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Ucima N, Tuka DD, Kimbongila MM, Lumbala PK, Biselele T, Tady BM, Nkidiaka ED, Aloni MN. Rare occurrence of ectopia cordis in a Congolese neonate. Pediatr Neonatol 2015; 56:132-3. [PMID: 25239725 DOI: 10.1016/j.pedneo.2014.05.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2014] [Revised: 05/02/2014] [Accepted: 05/12/2014] [Indexed: 11/18/2022] Open
Affiliation(s)
- Nancy Ucima
- Division of Neonatology, Department of Paediatrics, University Hospital of Kinshasa, School of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo.
| | - Deborah Debola Tuka
- Division of Cardiology, Department of Paediatrics, University Hospital of Kinshasa, School of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Mathonnet Matondo Kimbongila
- Division of Emergency, Department of Paediatrics, School of Medicine, University Hospital of Kinshasa, University of Kinshasa, Democratic Republic of Congo
| | - Paul Kasuyi Lumbala
- Division of Cardiology, Department of Paediatrics, University Hospital of Kinshasa, School of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Thérèse Biselele
- Division of Neonatology, Department of Paediatrics, University Hospital of Kinshasa, School of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Bruno Muyala Tady
- Division of Neonatology, Department of Paediatrics, University Hospital of Kinshasa, School of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Emmanuel Dimbu Nkidiaka
- Division of Neonatology, Department of Paediatrics, University Hospital of Kinshasa, School of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
| | - Michel Ntetani Aloni
- Division of Paediatric Haemato-Oncology and Nephrology, Department of Paediatrics, University Hospital of Kinshasa, School of Medicine, University of Kinshasa, Kinshasa, Democratic Republic of Congo
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Diagnosis of pentalogy of cantrell in the first trimester using transvaginal sonography and color Doppler. Case Rep Obstet Gynecol 2015; 2015:179298. [PMID: 25802780 PMCID: PMC4352946 DOI: 10.1155/2015/179298] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2014] [Revised: 02/08/2015] [Accepted: 02/08/2015] [Indexed: 11/30/2022] Open
Abstract
We report the prenatal diagnosis of Cantrell syndrome in the first trimester. During a routine transabdominal ultrasonographic examination, a midline supraumbilical abdominal wall defect including herniated liver and ectopia cordis with a large omphalocele containing the intestines and cystic hygroma was incidentally identified at the 12th week of gestation. A transvaginal sonography examination revealed a severe lumbosacral scoliosis in addition to the inability to visualize the abdominal aorta which was indicative of a severe intracardiac defect. The parents opted for pregnancy to be terminated. In this case report, we discuss the complementary role of transvaginal sonography and Doppler imaging in the diagnosis of Cantrell syndrome in early pregnancy.
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Martins CF, Serras I, Santos AV, Costa Braga A. Pentalogy of Cantrell: the complete spectrum. BMJ Case Rep 2014; 2014:bcr-2014-207556. [PMID: 25378274 DOI: 10.1136/bcr-2014-207556] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Cátia Filipa Martins
- Department of Gynecology-Obstetrics, Centro Hospitalar do Algarve, Portimão, Portugal
| | - Inês Serras
- Department of Pediatrics, Centro Hospitalar do Algarve, Portimão, Portugal
| | - Ana Vanessa Santos
- Department of Gynecology-Obstetrics, Hospital Fernando Fonseca, Amadora, Portugal
| | - Ana Costa Braga
- Department of Anatomic Pathology, Centro Hospitalar Lisboa Ocidental, Lisboa, Portugal
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Gabriel A, Donnelly J, Kuc A, Good D, Doros G, Matusz P, Loukas M. Ectopia cordis: a rare congenital anomaly. Clin Anat 2014; 27:1193-9. [PMID: 24753313 DOI: 10.1002/ca.22402] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Revised: 03/29/2014] [Accepted: 03/29/2014] [Indexed: 11/12/2022]
Abstract
Ectopia cordis (EC) is a rare congenital anomaly associated with the heart positioned outside of the thoracic cavity either partially or completely. The ectopic heart can be found along a spectrum of anatomical locations, including the cervical, thoracic and abdominal regions and in most cases, it protrudes outside the chest through a split sternum. Although the first case of EC was identified during the early 1600s only 91 cases have been reported since then in the literature. This review will discuss the history and prevalence of EC, its etiology, morphology, presentation and symptoms, complications, diagnosis, treatment and management and prognosis.
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Affiliation(s)
- Abigail Gabriel
- Department of Anatomical Sciences, St. George's University, School of Medicine, Grenada, West Indies; Department of Internal Medicine, Harlem Hospital, New York, New York
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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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Kheir AEM, Bakhiet EA, Elhag SMM, Karrar MZ. Pentalogy of Cantrell: case report and review of the literature. Sudan J Paediatr 2014; 14:85-88. [PMID: 27493395 PMCID: PMC4949922] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
Pentalogy of Cantrell is a syndrome that consists of five anomalies: a midline, upper abdominal wall abnormality; lower sternal defect; anterior diaphragmatic defect; diaphragmatic pericardial defect, and congenital abnormalities of the heart. The pathogenesis of this condition is not fully known yet, associations are common with this condition and treatment is extremely challenging. Prognosis and outcome depends on the type of the pentalogy of Cantrell and associated cardiac anomalies. It can be diagnosed reliably by antenatal ultrasound during the first trimester. We describe a Sudanese baby of undetermined sex who had the typical features of pentalogy of Cantrell and died shortly after birth.
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Affiliation(s)
- Abdelmoneim E M Kheir
- Department of Paediatrics and Child Health, Faculty of Medicine, University of Khartoum, Sudan
| | - Elghazali A Bakhiet
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Khartoum, Sudan
| | - Salma M M Elhag
- The Neonatal Unit, Soba University Hospital, Khartoum, Sudan
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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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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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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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Kaouthar H, Jihen A, Faten J, Hela M, Fatma O, Lilia C, Rafik B. Cardiac anomalies in Cantrell's pentalogy: From ventricular diverticulum to complete thoracic ectopia cordis. CARDIOLOGIE TUNISIENNE 2013; 9:94-97. [PMID: 25541632 PMCID: PMC4274934] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Cantrell's pentalogy is a very rare syndrome associating varying degrees of midline wall defects and congenital cardiac anomalies. It is characterized by a combination of five anomalies that are: a midline supra umbilical abdominal wall defect, a sternal defect, an anterior diaphragmatic defect, a diaphragmatic pericardial defect and a congenital intra cardiac defect. Ectopia cordis, defined as a developmental defect in which the heart is abnormally located partially or totally outside the thorax, is in some cases a part of this syndrome. We report two cases of Cantrell's pentalogy in which cardiac ectopia was complete in one case and limited to left ventricular diverticulum in the other case. Both cases had a common intracardiac defect which is a double outlet right ventricle. The first case underwent surgical repair of the intracardiac lesions with resection of the diverticulum associated to repair of the midline defects with good outcome. The second case that presented with complete extra thoracic ectopia cordis died because of sepsis. We review through this article the main characteristics of Cantrell's pentalogy, we highlight the diversity of anatomic lesions and study the prognosis of this syndrome.
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Lubala TK, Mutombo AM, Katamea T, Lubala N, Munkana AN, Kabuya MS, Monga JK, Luboya ON. [Sporadic thoracic ectopia cordis: clinical description of a case]. Pan Afr Med J 2012; 13:62. [PMID: 23346276 PMCID: PMC3549449] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2012] [Accepted: 10/30/2012] [Indexed: 11/04/2022] Open
Abstract
Nous décrivons un cas d'ectopia cordis, une malformation cardiaque congénitale extrêmement rare dans laquelle le coeur est partiellement ou complètement situé en dehors des limites de la cage thoracique. Dans le cas que nous décrivons, elle est thoracique et isolée. Ce cas a été diagnostiqué en salle de naissance au Katanga, au sud de la République Démocratique du Congo. Il s'agit du premier cas documenté chez un nouveau-né Congolais.
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Affiliation(s)
- Toni Kasole Lubala
- Faculté de Médecine, Université de Lubumbashi, 1825 Lubumbashi, République Démocratique du Congo,Centre Interdisciplinaire de Génétique au Congo, CIGEC, Lubumbashi, République Démocratique du Congo,Corresponding author: Toni Kasole Lubala, Faculté de Médecine, Université de Lubumbashi, 1825 Lubumbashi, République Démocratique du Congo
| | - Augustin Mulangu Mutombo
- Faculté de Médecine, Université de Lubumbashi, 1825 Lubumbashi, République Démocratique du Congo
| | - Tina Katamea
- Faculté de Médecine, Université de Lubumbashi, 1825 Lubumbashi, République Démocratique du Congo
| | - Nina Lubala
- Faculté de Médecine, Université de Lubumbashi, 1825 Lubumbashi, République Démocratique du Congo
| | - Arthur Ndundula Munkana
- Faculté de Médecine, Université de Lubumbashi, 1825 Lubumbashi, République Démocratique du Congo
| | - Maguy Sangaji Kabuya
- Faculté de Médecine, Université de Lubumbashi, 1825 Lubumbashi, République Démocratique du Congo
| | - Joséphine Kalenga Monga
- Faculté de Médecine, Université de Lubumbashi, 1825 Lubumbashi, République Démocratique du Congo
| | - Oscar Numbi Luboya
- Faculté de Médecine, Université de Lubumbashi, 1825 Lubumbashi, République Démocratique du Congo
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Ludwig K, Salmaso R, Cosmi E, Iaria L, De Luca A, Margiotti K, Valentina C, Manara R, Rugge M. Pentalogy of cantrell with complete ectopia cordis in a fetus with asplenia. Pediatr Dev Pathol 2012; 15:495-8. [PMID: 22900993 DOI: 10.2350/12-03-1169-cr.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Cantrell's pentalogy (CP) is a rare, mainly sporadic spectrum of congenital midline thoracoabdominal defects that includes sternal anomalies, ventral diaphragmatic hernia, partial absence of the pericardium, supraumbilical abdominal wall defects, and congenital heart malformations. The approximate incidence is 1 in 100 000, with a 2∶1 male predominance. A 25-year-old pregnant woman was referred to the Prenatal Diagnosis Unit of the University Hospital of Padua for multiple congenital malformations at 21 weeks of gestation. A level 2 ultrasound scan was performed and confirmed the presence of multiple anomalies compatible with the diagnosis of CP associated with complete ectopia cordis. Fetal autopsy furthermore revealed asplenia, which usually presents as part of the heterotaxia spectrum. To our knowledge, an association of CP and complete ectopia cordis with asplenia has never been reported so far.
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Affiliation(s)
- Kathrin Ludwig
- Department of Medicine (DIMED), Surgical Pathology and Cytopathology Unit, University of Padova, Padova, Italy
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Ergenoğlu MA, Yeniel AÖ, Peker N, Kazandı M, Akercan F, Sağol S. Prenatal diagnosis of Cantrell pentalogy in first trimester screening: case report and review of literature. J Turk Ger Gynecol Assoc 2012; 13:145-8. [PMID: 24592026 DOI: 10.5152/jtgga.2011.77] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2011] [Accepted: 10/08/2011] [Indexed: 11/22/2022] Open
Abstract
Pentalogy of Cantrell is a heterogeneous and rare thoraco-abdominal wall closure defect with the estimated prevalence of 1/65.000 to 1/200.000 births. Supraumbilical midline wall defect (generally omphalocele), deficiency of the anterior diaphragm and diaphragmatic peritoneum, defect of the lower sternum and several intracardiac defects are the components of Cantrell pentalogy. Etiology is unknown but a defect on the lateral mesoderm during the early stage of pregnancy is the most accepted hypothesis. Nowadays both 2- dimensional (2D) and 3-dimensional (3D) sonography are commonly used in diagnosis. In our case, a fetus with 11 weeks of gestation was reported as Cantrell pentalogy during first trimester screening. Additionally, unilateral limb defect and lumbar lordoscoliosis were detected through 3D sonography. Pregnancy was terminated according to parental desire. Karyotype was 46 XY. Early diagnosis is feasible in the first trimester if ectopia cordis and omphalocele exist. Additionally, development in ultrasound technology provides us with better visualization and early diagnosis. Prognosis seems to be poor in patients with complete Cantrell syndrome and patients with associated anomalies. Termination is the choice of treatment. Early diagnosis gives us a chance to reduce maternal morbidity and mortality related to termination.
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Affiliation(s)
- Mete Ahmet Ergenoğlu
- Department of Gynecology and Obstetrics, Faculty of Medicine, Ege University, İzmir, Turkey
| | - A Özgür Yeniel
- Department of Gynecology and Obstetrics, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Nuri Peker
- Department of Gynecology and Obstetrics, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Mert Kazandı
- Department of Gynecology and Obstetrics, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Fuat Akercan
- Department of Gynecology and Obstetrics, Faculty of Medicine, Ege University, İzmir, Turkey
| | - Sermet Sağol
- Department of Gynecology and Obstetrics, Faculty of Medicine, Ege University, İzmir, Turkey
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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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