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Heart Disease and Pectus Excavatum: An Underestimated Issue-Single Center Experience and Literature Review
Alice Ravasin1, Domenico Viggiano1, Simone Tombelli1
1Thoracic Surgery Unit, Careggi University Hospital, 50134 Florence, Italy.
Insights
Surgical repair of severe pectus excavatum (PE) is crucial for patients with heart disease, as chest depression can worsen cardiopulmonary issues. Corrective surgery improved underlying cardiac conditions in all patients studied.
Area of Science:
- Cardiology
- Thoracic Surgery
- Congenital Abnormalities
Background:
- Pectus excavatum (PE) is a congenital chest wall deformity.
- Severe PE can cause mechanical compression on the heart, exacerbating underlying cardiac conditions.
- This compression can lead to significant cardiopulmonary impairment.
Purpose of the Study:
- To highlight the importance of surgical repair of pectus excavatum in patients with coexisting heart disease.
- To evaluate the outcomes of surgical correction in patients with severe chest depression and cardiac conditions.
- To assess the impact of PE repair on underlying cardiological issues.
Main Methods:
- Retrospective review of four male patients undergoing PE repair from January 2023 to March 2024.
- Preoperative assessment included pulmonary function tests, chest CT, and cardiac evaluation.
- Surgical procedures included the Nuss procedure and a modified Ravitch procedure.
Main Results:
- Median Haller Index (HI) was five, indicating severe PE.
- Postoperative complications included prolonged air leak, atrial fibrillation, and atelectasis.
- Median hospital stay was 19.5 days with no 30-day mortality; all patients showed improvement in cardiac issues.
Conclusions:
- Surgical correction of pectus excavatum in patients with heart disease can resolve mechanical cardiac compression.
- PE repair is essential for managing associated cardiopulmonary impairment and improving hemodynamic consequences.
- Consideration of surgical correction is vital when PE is associated with severe cardiac diseases.
Abstract:
Pectus excavatum (PE) can be associated with either congenital or acquired heart disease. This study highlights the importance of PE surgical repair in cases of severe chest depression on the heart in underlying cardiac diseases exacerbating cardiopulmonary impairment. From January 2023 to March 2024, four male patients underwent PE repair, having heart disease including pericarditis, mitral valve prolapse, ventricular fibrillation arrest and type 1 second-degree atrioventricular block. PE severity was determined by the Haller index (HI). Preoperative assessment included a pulmonary function test, chest computed tomography and cardiac evaluation. The Nuss procedure was performed in three patients, whereas, in one patient, it was performed in combination with a modified Ravitch procedure. The median HI was five. The median time of chest tube removal was 6.5 days. Postoperative complications were prolonged air leak, atrial fibrillation and atelectasis. The median length of hospital stay was 19.5 days, and no 30-day postoperative mortality was recorded. In all patients, surgical repair helped to resolve the underlying cardiological issues, and surgical follow-ups were deemed regular. PE is generally an isolated congenital chest wall abnormality, and, when associated with a heart disease, it can have severe life-threatening hemodynamic consequences due to mechanical compression on the heart for which surgical corrections should be considered.
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