Pectus excavatum requiring temporary pacemaker implantation before Nuss procedure: a case report.

Area of Science:

• Cardiology
• Thoracic Surgery
• Medical Devices

Background:

• Pectus excavatum, a common chest wall deformity, can be associated with cardiac arrhythmias.
• Severe conduction blocks requiring intervention before surgical correction are rare.

Observation:

• A young patient with pectus excavatum presented with a significant chest wall deformity and a second-degree atrial-ventricular (AV) block (Mobitz II).
• Preoperative evaluation, including ECG and Holter monitoring, confirmed both first-degree and second-degree (Mobitz II) AV block.
• The Haller index indicated the need for the Nuss procedure, a minimally invasive surgical correction.

Findings:

• Temporary pacemaker implantation was performed under local anesthesia prior to the Nuss procedure.
• The pacemaker was removed post-operatively after the patient recovered from general anesthesia.
• Postoperative Holter monitoring revealed the persistence of the conduction defect, suggesting an intrinsic issue with the cardiac conduction system rather than mere compression.

Implications:

• Temporary pacemaker placement was crucial for the safe and successful execution of the Nuss procedure in this patient.
• The findings suggest that severe AV blocks in pectus excavatum patients may stem from the conduction system itself.
• This case underscores the importance of thorough cardiac evaluation in pectus excavatum patients and individualized management strategies.