Right Ventricular Compression From Pectus Excavatum: A Reversible Cause of Ventricular Dysfunction

Pectus excavatum can rarely result in clinically significant right ventricular (RV) compression, leading to impaired diastolic filling, reduced stroke volume, and secondary biventricular dysfunction involving both the right and left ventricles. We report a 19-year-old male who presented with progressive exertional dyspnea and was found to have severe pectus excavatum with a Haller index of 5.8 on cardiac magnetic resonance imaging and 3.6 on computed tomography. Multimodal cardiac evaluation demonstrated focal RV compression, moderate RV systolic dysfunction on cardiac MRI with a right ventricular ejection fraction (RVEF) of 31%, mild left ventricular (LV) systolic dysfunction with an ejection fraction of 44%-45%, and trivial mitral and tricuspid regurgitation. Spirometry was overall normal, without obstructive changes or exercise-associated bronchoconstriction, and electrocardiography revealed marked right-axis deviation. Coronary computed tomography angiography demonstrated normal coronary anatomy, while cardiac MRI showed no delayed gadolinium enhancement to suggest myocardial scar or infiltrative cardiomyopathy. In the absence of alternative clinical or imaging evidence for another cardiomyopathic process, the patient met morphologic and physiologic criteria for surgical repair and underwent minimally invasive correction with pectus bar placement without complication. At five-month follow-up, he reported resolution of dyspnea, although repeat postoperative cardiac imaging had not yet been performed. This case emphasizes the importance of recognizing extrinsic RV compression from pectus excavatum as a surgically correctable and likely reversible contributor to ventricular dysfunction and highlights the role of comprehensive imaging in guiding timely surgical intervention.