Figure 2

Operative findings. (a) Lowermost costal cartilage resection is performed for cartilage approximation; (b) Approximations of both costal cartilages are attempted, but the high tension of the string tying the cartilages prevents obtaining optimal results; (c) Permacol® patch of size similar to the defect is temporarily affixed onto the left costal cartilage by using a 3–0 Ethibond and cut into the appropriate size. The stitches on the right side is close to the left suture site to minimize the size of the Permacol® patch for the approximation of costal cartilages, and the bottom area of the patch is used to reinforce the diaphragm and peritoneum defect areas; (d) follow up CT shows no thoraco abdominal defect at the heart protruding site (white arrow).