Ectopia cordis: a novel palliative care technique

Abstract

Complete ectopia cordis in the newborn represents a significant management challenge. There are minimal data available to inform optimal clinical care for those infants with coexisting complex congenital heart disease who are therefore not candidates for surgical intervention. The exteriorisation of the heart and absence of the pericardial sac requires meticulous wound care to prevent desiccation of the myocardium and to minimise infection risk. Additionally, the technique selected must address the risk of occlusion of the cardiac vascular pedicle and abrasion between the mobile myocardium and dressing surface. We report a novel approach to wound management and integrated palliative care that enabled community-based care. Our patient, a full-term male infant with complete ectopia cordis was born in good condition by assisted vaginal delivery. He was discharged from hospital on day 8 and was cared for in the community until his demise from cardiac failure on day 15.

Ectopia Cordis: A Case Report and Review of Literature

“…The immediate treatment consists in resuscitation and coverage of the exposed heart and viscera with salinesoaked gauze or adherent plastic drapes to prevent desiccation [3,12]. Surgery in complete ectopia cordis remains a challenge worldwide, despite the advances in neonatal cardiac surgery [3,5].…”

“…Five surgical steps are identified after complete survey for additional congenital defects: closure of the chest wall defect, closure of the sternal defect, repair of the associated omphalocele, reduction of the heart into the chest cavity and repair of the intra-cardiac defect [1,3,4]. Some authors proposed a new approach to wound management and integrated palliative care that enabled community-based care for the management of complete ectopia cordis [12].…”