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Ectopia cordis: A case report of pre-surgical care in resource-limited setting
Jay Lodhia1, Hillary Chipongo2, Kondo Chilonga1
1Department of General Surgery, Kilimanjaro Christian Medical Center, P O Box 3010, Moshi, Tanzania; Kilimanjaro Christian Medical University College, Faculty of Medicine, P O Box 2240, Moshi, Tanzania.
Insights
Ectopia cordis, a rare congenital malformation, requires specialized care. This case highlights successful stabilization and transfer of a newborn with this condition in a resource-limited setting.
Area of Science:
- Congenital Malformations
- Pediatric Surgery
- Neonatal Care
Background:
- Ectopia cordis is a rare congenital anomaly involving defective thoracic midline fusion, leading to the heart being located outside the chest cavity.
- This condition is a surgical emergency requiring specialized intervention, often challenging in resource-limited settings lacking prenatal screening and advanced facilities.
Purpose of the Study:
- To describe the management of a newborn with ectopia cordis in a resource-limited setting.
- To emphasize the importance of stabilization and transfer to a specialized center.
Main Methods:
- Presentation of a case involving a newborn male with ectopia cordis and abdominal viscera outside the body cavities.
- Sustaining the infant at a facility without cardiac surgery or cardiology expertise until referral.
Main Results:
- The infant was successfully sustained and transferred to a specialized cardiac institute.
- Demonstrates the feasibility of providing essential care in resource-limited environments.
Conclusions:
- Basic care can sustain infants with ectopia cordis until definitive management is available, even with limited resources.
- Effective management involves stabilization and timely referral to specialized centers.
Introduction And Importance:
Ectopia cordis is a rare congenital malformation of thoracic midline fusion that presents as location of the heart outside the open chest cavity. This presents as a surgical emergency and demands early and specialized intervention. Particularly in resource-limited settings, where prenatal ultrasonography screening is not done, these children are often born in facilities without the capability of managing such conditions definitively, necessitating them to be referred to a specialized centre. At lower health facilities, the challenge is in ensuring that the child is kept stable and protected from infection until they can reach a centre with the facilities required for care. This report describes the management give to such a child until they were successfully handed over to a cardiac institute.
Case Presentation:
We present a newborn male baby delivered at term to a mother from a low socio-economic background with his heart and abdominal viscera outside the thoracic and abdominal cavity. Despite presenting at a centre without cardiac surgery facilities or cardiologists, they were sustained until referral.
Clinical Discussion:
Ectopia cordis is a rare congenital anomaly characterized by defect in the fusion of the anterior chest wall resulting in the abnormal extra-thoracic location of the heart. Five types exist; cervical type with worst prognosis, attempts can be made to re-locate the heart and close the thoracic defect surgically.
Conclusion:
Even with limited resources, it is possible to provide the basic care necessary to sustain a child with this complex anomaly until definitive management can be provided.
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