Simultaneous aortic valve replacement and pectus excavatum correction in a 76-year-old man

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Adult Congenital Heart Disease

Background:

• Severe pectus excavatum can cause significant cardiopulmonary complications, including heart displacement.
• Aortic valve regurgitation necessitates surgical intervention.
• Simultaneous correction of pectus excavatum and cardiac conditions is complex.

Observation:

• A 76-year-old male presented with aortic valve regurgitation and severe pectus excavatum (Haller index 6.40).
• Physical examination revealed a notable chest concavity.
• Chest CT confirmed leftward heart displacement due to the sternal deformity.

Findings:

• A simultaneous aortic valve replacement and pectus excavatum correction were performed.
• The surgery was lengthy (570 min) with significant blood loss requiring high-volume transfusion.
• Postoperative complications included hypercapnia and sputum retention, necessitating reintubation and tube feeding.
• The patient was successfully weaned from mechanical ventilation on postoperative day 14 and is doing well at 1-year follow-up.

Implications:

• Simultaneous surgical correction of severe pectus excavatum and aortic valve disease is feasible in adult patients.
• Careful perioperative management is crucial to mitigate complications associated with combined procedures.
• This approach may offer a viable solution for patients with coexisting cardiac and severe chest wall deformities.