Cardiac dysfunction after operative correction of a thoracic hyperkyphosis in a patient with a severe pectus...

Thoracic hyperkyphosis can occur idiopathically, in the context of Scheuermann's disease, or in association with neuromuscular or metabolic disorders. Treatment depends on the patient's age, severity of the deformity, and underlying conditions. Conservative measures such as physiotherapy and reclination bracing are used in mild cases, whereas surgical correction is indicated for kyphosis exceeding 60-70°. A known association exists between hyperkyphosis and pectus excavatum, the latter of which can cause cardiac symptoms. However, the impact of surgical kyphosis correction on cardiac symptoms in patients with concurrent pectus excavatum remains unclear.

We present the case of a boy born in 2006 with progressive thoracic hyperkyphosis and pectus excavatum. Despite conservative therapy involving physiotherapy and bracing, the deformity progressed. In December 2023, a dorsal correction spondylodesis (Th6-L2) with Smith-Peterson osteotomies (Th8-L1) was performed. The kyphosis was corrected from 108° to 42°. Postoperatively, the patient developed tachycardia and dizziness. A pericardial effusion and a newly diagnosed right bundle branch block were detected. Radiological evaluation showed a reduction in the retrosternal space from 7.5 cm to 5.2 cm. Subsequently, surgical correction of the pectus excavatum was performed, leading to the resolution of symptoms and an increase in the retrosternal space to 8.7 cm.

This case study demonstrates that surgical correction of thoracic hyperkyphosis in the presence of pectus excavatum can lead to the clinical manifestation of previously asymptomatic cardiac issues. Due to the biomechanical interaction between the spine, ribs, and sternum, deformities in this region can influence each other. We recommend checking preoperatively whether pectus excavatum is present and then correcting it surgically as a priority to avoid cardiac complications.