Emergent cardiopulmonary bypass during pectus excavatum repair

Area of Science:

• Cardiothoracic Surgery
• Pediatric Surgery
• Thoracic Surgery

Background:

• Pectus excavatum is a congenital chest wall anomaly impacting cardiopulmonary function, often requiring surgical correction.
• The minimally invasive Nuss procedure is a standard treatment for pectus excavatum in pediatric and adult populations.
• While generally safe, the thoracoscopic approach carries risks of intraoperative and postoperative complications.

Observation:

• A 29-year-old male with Marfan syndrome and prior mitral valve repair experienced cardiac perforation during a Nuss procedure.
• The complication necessitated immediate emergency cardiopulmonary bypass for surgical repair.
• This event highlights the potential for severe cardiac injury during minimally invasive pectus excavatum repair.

Findings:

• Cardiac perforation is a rare but critical complication of the Nuss procedure.
• Prompt recognition and management, including emergent cardiopulmonary bypass, are essential for patient survival.
• The case underscores the need for comprehensive institutional readiness for managing surgical emergencies.

Implications:

• Surgeons, anesthesiologists, and healthcare institutions must maintain vigilance for potential cardiac complications during Nuss procedures.
• Readiness includes having cardiac surgical backup, perfusionists, and adequate blood products readily available.
• This preparedness is vital for mitigating risks and ensuring optimal outcomes in patients undergoing pectus excavatum repair.