ALERT!
This site is not optimized for Internet Explorer 8 (or older).
Please upgrade to a newer version of Internet Explorer or use an alternate browser such as Chrome or Firefox.
A Novel Subxiphoid Approach of Left Ventricular Apical Diverticulum Excision: A Video Illustration
Goja S, Kumar Chaudhary S, Reddy P. A Novel Subxiphoid Approach of Left Ventricular Apical Diverticulum Excision: A Video Illustration. May 2025. doi:10.25373/ctsnet.29110031
Introduction
The Pentalogy of Cantrell is a constellation of multiple congenital anomalies that includes defects in supraumbilical peritoneum, anterior diaphragm, apical pericardium, and the lower end of the sternum. In this video, the authors describe a novel subxiphoid approach to address these challenges.
Case Presentation
An otherwise asymptomatic neonate presented with pulsatile epigastric mass. An echocardiogram showed a mesocardiac with a large perimembranous ventricular septal defect (VSD) and an apical left ventricular diverticulum extending to the umbilicus, contracting in synchrony with cardium. Computed tomography revealed a diverticulum from the left ventricular apex, with a focal lower sternal and diaphragmatic defect and umbilical herniation of bowel loops. Surgical resection was indicated because the tip of the diverticulum was thinned, posing a risk of rupture. The operation was carried out via a subxiphoid midline incision, which was extended to the umbilicus. The diverticulum was ligated through the diaphragmatic defect and excised. The diaphragmatic, rectal, and umbilical defects were repaired. Closure of the VSD was staged for when the patient reached six-months old.
Conclusion and Discussion
The authors’ novel subxiphoid approach avoids the need for sternotomy, thereby promoting better postoperative respiratory mechanics and facilitating future staged cardiac procedures. A single incision to address both the cardiac defect and the associated anterior abdominal wall defect highlights the less invasive nature with this approach.
References
- Cantrell JR, Haller JA, Ravitch MM. A syndrome of congenital defects involving the abdominal wall, sternum, diaphragm, pericardium, and heart. Surg Gynecol Obstet. 1958;107:602–14
Disclaimer
The information and views presented on CTSNet.org represent the views of the authors and contributors of the material and not of CTSNet. Please review our full disclaimer page here.
Printer-friendly
