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Echocardiographic diagnosis of right ventricular inflow compression associated with pectus excavatum during spinal
James M Galas1, Mary E van der Velde, S Devi Chiravuri
1Pediatrics Cardiology, University of Michigan Health System, MI, USA. jgalas@med.umich.edu
Introduction:
Pectus excavatum is commonly viewed as a benign condition. Associated alterations in hemodynamics are rare. We present an unusual case of right ventricular inflow obstruction and hemodynamic compromise as a consequence of pectus excavatum encountered during surgical intervention.
Case:
a 15-year-old male with pectus excavatum and thoracolumbar scoliosis developed severe hypotension after induction of general anesthesia and placement in the prone position for elective spinal fusion. A transesophageal echocardiogram revealed anterior compression of the right heart by the sternum with peak and mean right ventricular inflow gradients of 7 and 4 mm Hg, respectively. The gradient resolved with supine positioning and was reproduced with direct compression of the sternum.
Conclusions:
Although pectus excavatum is generally a benign condition, the cardiologist should be aware of the potential for serious hemodynamic compromise related to positioning in these patients.
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