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Simultaneous repair of pectus excavatum and congenital heart disease
M M DeLeon1, K E Magliato, P T Roughneen
1Department of Thoracic-Cardiovascular Surgery, Loyola University Medical School, Maywood, Illinois, USA.
Insights
This study presents a novel surgical approach for simultaneous pectus repair and atrial septal defect closure in children, utilizing a short incision and avoiding sternal division. The technique ensures excellent cosmetic outcomes and preserves chest growth potential.
Area of Science:
- Pediatric Cardiac Surgery
- Thoracic Deformity Correction
Background:
- Traditional pectus deformity repair in adults involves extensive incisions and sternal division, leading to poor cosmetic results and impaired chest growth in pediatric patients.
- Sternal devascularization during conventional repair can compromise healing and development in children.
Observation:
- A minimally invasive technique was employed for simultaneous pectus repair and atrial septal defect closure in two pediatric patients.
- The approach utilized a short longitudinal incision, avoiding sternal splits, and involved extraperichondrial cartilage excision and sternal mobilization.
Findings:
- A transverse wedge sternal resection at the third cartilage level facilitated excellent exposure for the intracardiac procedure.
- Both patients demonstrated excellent cosmetic outcomes at 1 and 4 years postoperatively.
- The technique preserved sternal integrity and neurovascular structures, promoting unimpeded chest growth.
Implications:
- This innovative surgical method offers a promising alternative for pediatric patients requiring combined pectus repair and cardiac surgery.
- The approach minimizes surgical trauma, improves aesthetic results, and supports normal thoracic development in children.
- Further studies are warranted to evaluate the long-term efficacy and applicability of this technique in a larger pediatric cohort.
Abstract:
Most repair of heart lesions and pectus deformity has been performed in adult patients using long incisions, sternal splits, excision of deformed cartilages, and sternal turnover operations that could result in poor cosmesis and chest growth in children because of sternal devascularization. We performed simultaneous pectus repair and atrial septal defect closure in 2 children using a short longitudinal incision and avoiding a transverse or longitudinal sternal split. After extraperichondrial excision of the deformed cartilages and mobilization of the sternum from the neurovascular bundles, a transverse wedge of sternum was removed at the level of the third cartilages, allowing cephalad retraction of the sternum and providing excellent exposure for the intracardiac operation. The cosmetic appearance remains excellent in both patients at 1 and 4 years postoperatively.