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The Nuss procedure for pectus excavatum during atrial septal defect closure through a minimal right oblique

Guangxian Yang1,2, Xicheng Deng2, Yifeng Yang1

  • 1Department of Cardiovascular Surgery, The Second Xiangya Hospital of Central South University.

Medicine
|January 18, 2019
PubMed

Insights

This study presents a novel surgical approach for pectus excavatum (PE) and atrial septal defect (ASD) in a child. Combining the Nuss procedure for PE with ASD repair via infra-axillary thoracotomy offers improved aesthetic and surgical outcomes.

Area of Science:

  • Pediatric Surgery
  • Thoracic Surgery
  • Congenital Heart Disease Management

Background:

  • Pectus excavatum (PE) can coexist with congenital heart defects (CHD), necessitating complex management strategies.
  • Surgical approaches have shifted from staged to simultaneous repair of PE and concurrent CHD.
  • The optimal surgical technique for combined PE and CHD remains a subject of ongoing discussion.

Observation:

  • A 3.6-year-old patient presented with pectus excavatum (PE) and an atrial septal defect (ASD).
  • Diagnostic imaging revealed a Haller index of 4.4 for PE and a secundum ASD unsuitable for interventional closure.
  • The patient had clinical signs of PE and an audible heart murmur.

Findings:

  • Concomitant repair of PE using the Nuss procedure and ASD closure via cardiopulmonary bypass was successfully performed.
  • The surgery utilized a minimal right oblique infra-axillary thoracotomy, avoiding a sternal incision.
  • Postoperative assessments confirmed satisfactory closure of the ASD and correction of PE, with an uneventful recovery.

Implications:

  • This combined approach offers a safe and effective alternative for selected pediatric patients with concurrent PE and ASD.
  • Minimally invasive thoracotomy avoids complications associated with sternal division, such as bleeding and dehiscence.
  • This technique potentially leads to superior aesthetic results and improved surgical outcomes in pediatric thoracic surgery.
Abstract

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