Simultaneous repair of pectus excavatum and congenital heart disease without cardiopulmonary bypass or sternal osteotomy
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CASE REPORT
Open Access
Simultaneous repair of pectus excavatum and congenital heart disease without cardiopulmonary bypass or sternal osteotomy Yong Sun1,2, Peng Zhu1,2 and Shao-Yi Zheng2*
Abstract A 8-year-old girl with severe pectus excavatum and an atrial septal defect had simultaneous repair of the both defects, using thransthoracic occlusion for atrial septal defect and improved Nuss technique for the pectus excavatum. Neither cardiopulmonary bypass nor sternotomy was required in this procedure. Details of the procedure and outcome are described. Keywords: Pectus excavatum, Congenital heart disease, Minimally invasive surgery
Background Coexisting pectus excavatum and congenital heart disease is not uncommon. Traditionally, the approach to this problem has been to repair each one with a separate surgical procedure because of fear of increased complications from bleeding, infections, and anesthesia [1]. More recently, many reports of successful combined repair have been published [2,3]. These procedures of pectoralis muscle flaps elevation, resection of the deformed costal cartilages and sternal osteotomy may be associated with increased bleeding because of the cardiopulmonary bypass (CPB) for repair of congenital heart defect. Concomitant repair of a congenital heart disease and pectus deformity is still a challenge. We report a simultaneous repair of an atrial septal defect and pectus excavatum with a technique that combined of thransthoracic occlusion for atrial septal defect and mordified Nuss procedure. Neither CPB nor sternal osteotomy was required in this procedure. Case presentation In Jul 2011, an 8-year-old girl was investigated for chest tightness. She had a severe pectus excavatum and atrial septal defect (ASD) (Figure 1A). Computed tomographic * Correspondence: [email protected] 2 Department of Cardiovascular Surgery, Guangdong General Hospital, Guangdong Acedemy of Medical Sciences, 96 Dongchuan Road, Guangzhou 510080, China Full list of author information is available at the end of the article
scan confirmed the Haller index was 6.2 (Figure 2A) and Echocardiography showed a secundum atrial septal defect with 15 mm size (Figure 3A). Pulmonary function tests were within normal range. Thransthoracic occlusion for atrial septal defect and Nuss technique for the pectus excavatum were considered for Simultaneous repair. The sites of the operation which included the lowest concaves of the sternum, the highest points of both ribs and the cutting area of the left and right pectus were marked prior to the operation. A 3 cm incision was first made in the patient’s right anterior 4th intercostal space. After the pericardium was opened, a 5 mm incision was made in the right atrium for the insertion of the delivery sheath. Under continuous TEE guidance, we used a diameter of 20 mm occluder (Shanghai Memory Alloy Company, Shanghai, China) to close the ASD. The procedure was completed by inspection for residual shunting, atrioventricular valve distortion, or obstruction of the superior vena cava, IVC
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