Cardiac perforation during minimally invasive repair of pectus excavatum: a rare complication

Area of Science:

• Cardiothoracic Surgery
• Pediatric Surgery
• Surgical Complications

Background:

• Minimally invasive repair of pectus excavatum (MIRPE) is a common procedure with a generally low complication rate.
• However, life-threatening complications (LTCs) associated with MIRPE, particularly cardiac injury, are underreported.
• Accurate reporting of rare adverse events is crucial for risk assessment and surgical training.

Observation:

• A 12-year-old female underwent MIRPE for severe asymmetric pectus excavatum (Haller index 4.9).
• During the procedure, cardiac arrhythmias, hypotension, and bilateral hemothorax developed after pectus bar placement.
• Emergency thoracotomy revealed cardiac perforation (CP).

Findings:

• The cardiac perforation was successfully repaired, and the pectus bar was ultimately implanted.
• The patient recovered well and was discharged on postoperative day 11, remaining asymptomatic at 10-month follow-up.
• This case underscores the potential for severe cardiac injury during MIRPE, even in experienced hands.

Implications:

• Reporting rare complications like cardiac perforation during MIRPE is essential for understanding the true incidence of LTCs.
• Maintaining high vigilance among pediatric surgeons is critical for early detection and management of such adverse events.
• This case contributes to the literature on MIRPE complications, aiding in the refinement of surgical techniques and patient safety protocols.