[Stanford type a acute aortic dissection with pectus excavatum]

Area of Science:

• Cardiothoracic Surgery
• Congenital Chest Wall Deformities
• Aortic Disease Management

Background:

• Pectus excavatum, a chest wall abnormality, can coexist with cardiac and aortic conditions, complicating surgical planning.
• Acute Stanford type A aortic dissection requires timely surgical intervention, often necessitating median sternotomy.

Observation:

• Two patients with pectus excavatum and acute Stanford type A aortic dissection presented with challenges to standard surgical access.
• The typical median sternotomy approach was deemed unsuitable due to cardiac displacement in one patient.

Findings:

• A combined sternotomy and left anterior thoracotomy approach provided excellent surgical exposure in the first patient.
• A left-sided costotomy of four ribs successfully facilitated adequate surgical access in the second patient, avoiding median sternotomy risks.

Implications:

• Modified surgical techniques, including combined thoracotomy or costotomy, offer safe and effective alternatives for aortic dissection repair in patients with pectus excavatum.
• These approaches mitigate the risks associated with median sternotomy in this specific patient population, improving surgical outcomes.