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Sternal cleft and pectus excavatum: an overlooked congenital association?

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Abstract

Background

Sternal cleft (SC), a rare thoracic malformation, is associated with pectus excavatum (PE) in 2.6–5% of cases. It remains unclear if these conditions are congenitally linked or if SC repair triggers PE. To investigate the potential higher frequency of PE in SC cases, we conducted a retrospective study of our SC patients.

Methods

We assessed PE incidence, progression, and management in SC patients treated at our institute from 2006 to 2022. When available, we collected pre-SC repair CT scan data, calculating the Haller Index (HI) and Correction Index (CI) and compared them to a selected control group.

Results

Among 8 SC patients, 7 had concomitant PE (87.5%), varying in severity. PE management ranged from observation to thoracoplasty, depending on its degree. We observed a significant pre-operative CI difference between SC and control group patients (p < 0.00001). In the last two SC repair cases, we attempted concurrent PE prevention or treatment.

Conclusion

Our findings suggest an underestimated association between PE and SC in the existing literature. SC patients may exhibit a predisposition to PE from birth, which may become more apparent with growth after SC repair. Consequently, PE prevention or treatment should be considered during SC repair procedures.

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Funding

The authors declare that no grants were received for this article.

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Authors and Affiliations

  1. Pediatric Surgery Department, IRCCS Istituto Giannina Gaslini, Via Gerolamo Gaslini 5, 16147, Genoa, Italy

    Liliana Piro, Federica Lena, Arianna Roggero, Girolamo Mattioli & Michele Torre

  2. Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Science, University of Genoa, Genoa, Italy

    Liliana Piro, Federica Lena, Arianna Roggero & Girolamo Mattioli

  3. Pediatric Thoracic and Airway Surgery Unit, IRCCS Istituto Giannina Gaslini, Largo Gaslini 5, 16147, Genoa, Italy

    Michele Torre

  4. Department of Radiology, IRCCS Istituto Giannina Gaslini, Largo Gaslini 5, 16147, Genoa, Italy

    Nicola Stagnaro

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  1. Liliana Piro
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  2. Federica Lena
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All authors have contributed significantly to the content of the article and have read and approved the submission of the manuscript.

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Correspondence to Liliana Piro.

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The authors declare no conflict of interest.

Ethical approval

Ethical committee approval was obtained on 23/05/2022, protocol n°. 235/2022–DB id 12426, CER Liguria.

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The authors state that they have obtained consent for publication of the images in Figs. 2, 3 and 4.

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Piro, L., Lena, F., Roggero, A. et al. Sternal cleft and pectus excavatum: an overlooked congenital association?. Pediatr Surg Int 40, 105 (2024). https://doi.org/10.1007/s00383-024-05686-0

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