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Intraventricular Thrombosis and Pulmonary Embolism Post-Nuss Procedure: A Rare Case of Chronic Bar Displacement in a
Zhanyu Xu1, Guanbiao Liang1, Cheng Luo1
1Department of Thoracic and Cardiovascular Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, China.
Abstract:
This novel report presents the first known case, to our knowledge, of a 16-year-old male patient who experienced intraventricular thrombosis and pulmonary embolism after a Nuss procedure for pectus excavatum, attributed to chronic bar displacement. Two years after the operation, the patient experienced post-exercise cough and hemoptysis, which led to his admission. Imaging revealed pulmonary embolism, thrombosis in the right ventricular outflow tract, and lung infiltrative lesions. We hypothesize that the chronic bar displacement led to its embedment in the right ventricle, resulting in thrombus formation, which subsequently contributed to partial pulmonary embolism. Surgery revealed the bars' intrusion into the right ventricle and lung. This case highlights the risk of severe complications from bar displacement in the Nuss procedure, which necessitates long-term follow-up evaluation, caution against strenuous activities after surgery, and use of thoracoscopic guidance during bar implantation and removal. It underscores the importance of vigilant evaluation for late-stage complications in patients with respiratory distress or thrombosis after a Nuss procedure.
Insights
A Nuss procedure for pectus excavatum caused severe complications in a teen, including intraventricular thrombosis and pulmonary embolism due to chronic bar displacement. This highlights the need for long-term monitoring and careful surgical technique.
Area of Science:
- Cardiothoracic Surgery
- Pediatric Cardiology
- Medical Case Reports
Background:
- The Nuss procedure is a common surgical technique for correcting pectus excavatum.
- Complications, though rare, can arise from the placement and stability of the pectus bars.
Observation:
- A 16-year-old male presented with cough and hemoptysis two years post-Nuss procedure.
- Imaging revealed pulmonary embolism and intraventricular thrombosis, with bars intruding into the right ventricle and lung.
Findings:
- Chronic bar displacement from the Nuss procedure led to embedment in the right ventricle.
- This embedment caused thrombus formation and subsequent pulmonary embolism.
- Surgical exploration confirmed bar intrusion into cardiac and pulmonary structures.
Implications:
- This case underscores the risk of late-onset, severe complications from Nuss procedure bar displacement.
- Long-term follow-up, cautious activity guidelines, and precise surgical techniques (including thoracoscopic guidance) are crucial.
- Vigilant evaluation for respiratory distress or thrombosis is essential in post-Nuss patients.
