Anterior congenital diaphragmatic hernia through
the foramen of Morgagni was first described by
Giovani Morgagni in 1761.[
1,
6] The defect results from
the failure of the fibrotendinous portion of the pars
sternalis to fuse with the fibrotendinous part of the
costochondral arches.[
1,
2,
6] Most (%90) CMH occur
on the right side, 2% on the left side, and 8% occur
bilaterally. Pericardial attachment to the diaphragm,
which is more common on the left side, supports and
protects that side. The most common contents of the
hernia sac are the colon, small bowels, liver, omentum,
and stomach.[
6]
It is well-known that CMH may be associated with
other congenital anomalies such as congenital heart
diseases, Down syndrome, intestinal malrotation,
omphalocele, pectus carinatum, and genitourinary
anomalies.[3] However, chromosomal anomalies which
are associated with CMH are more significant, in terms
of whether it is an inheritable defect.[7,8] In large series,
it was reported that the incidence of CMH associated
with Down syndrome was approximately 20%.[3] It
has also been reported that there is a possibility
of muscular deficiency of the ventral paramedian
segment of the body wall related to the diaphragm in
Down syndrome.[9]
There is a common consensus which CMH should
be treated surgically in symptomatic patients. Opinions
differ as to the best surgical approach, whether transthoracic or transabdominal.[10,11] However, in
patients undergoing open heart surgery for congenital
heart defects, as in our case, transsternal exposure and
repair is also a possible option.[12] Another controversial
issue is the removal of the hernia sac during repair.
Although some authors recommend excision of the
hernia sac, others prefer to leave it as to avoid the
possibility of pneumopericardium.[3,13] However, there
is no available data in the literature indicating whether
leaving a hernia sac influences the rate of recurrence.
In conclusion, as congenital Morgagni hernias
can be associated with congenital cardiac diseases, it
should be kept in mind, in patients undergoing open
heart surgery via sternotomy approach, that these
defects can be repaired with transsternal approach as
effective as other approaches without an additional
incision.
Declaration of conflicting interests
The authors declared no conflicts of interest with respect
to the authorship and/or publication of this article.
Funding
The authors received no financial support for the research
and/or authorship of this article.
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