Sudden cardiac arrest during Nuss procedure for pectus excavatum

Cardiac arrest during the Nuss procedure is the most serious complication and is related to cardiac injury by the surgical instruments and pectus bars. To avoid the cardiac injury, there are several techniques with various devices, including crane and wire suture, lifting hook, the Kent or Langenbeck retractor, and the Vacuum Bell device. However, a case of cardiac arrest without direct cardiac injury during the Nuss procedure has been reported in the pectus excavatum patient with coronary-to-pulmonary arterial shunts. Recently, we encountered a case of cardiac arrest without cardiac abnormalities in preoperative studies and cardiac injury during the Nuss procedure.