Pectus excavatum and cardiac dysfunction: a case report with pre- and post-operative haemodynamic studies

Area of Science:

• Cardiology
• Thoracic Surgery
• Exercise Physiology

Background:

• Pectus excavatum, a congenital chest wall deformity, can lead to significant cardiac and pulmonary complications.
• Supraventricular tachycardia (SVT) is a common cardiac arrhythmia, often exacerbated by physical exertion.

Observation:

• A 48-year-old male patient with severe pectus excavatum experienced incapacitating, exercise-induced supraventricular tachycardia.
• Hemodynamic monitoring revealed abnormal increases in right heart pressures, particularly right atrial pressure, preceding SVT during exercise.
• Similar episodes were documented during both supine and upright exercise protocols.

Findings:

• Surgical correction of the pectus excavatum deformity resulted in complete resolution of the supraventricular tachycardia.
• Post-operative exercise testing demonstrated normal hemodynamic responses, with no recurrence of the arrhythmia.
• Pre- and post-operative assessments strongly suggest a causal link between the sternal depression and the cardiac abnormality.

Implications:

• This case highlights pectus excavatum as a potential, albeit uncommon, cause of exercise-induced supraventricular tachycardia.
• Surgical intervention for pectus excavatum can effectively treat associated cardiac arrhythmias.
• Understanding the relationship between chest wall deformities and cardiac function is crucial for comprehensive patient management.