Simultaneous operative repair of pectus excavatum and concurrent congenital heart defects

Abstract

Objectives: The aim of this study is to describe an effective surgical strategy for the treatment of children with pectus excavatum (PE) and concurrent congenital heart defect (CHD).

Methods: We retrospectively reviewed the medical records of all children (n = 16) who underwent simultaneous repair of PE with concurrent CHD at the Hunan Children's Hospital from July 2007 to December 2017. Among them, 7 patients had a simple atrial septal defect (ASD); 4 patients had a simple ventricular septal defect (VSD); 3 patients had both VSD and ASD; 1 patient had VSD, ASD and patent ductus arteriosus; and 1 patient had VSD complicated by pulmonary hypertension. To repair PE, we performed one of the 3 procedures: an open sternal elevation involving freeing the tissue from the posterior sternum and lifting the sternum by wires, a Nuss repair or a repair with a custom-made sternal lifting device. The CHDs were repaired using one of the 3 methods as well: open heart surgery using cardiopulmonary bypass, transcatheter closure under echocardiography or X-ray-guided percutaneous intervention.

Results: In all 16 patients, the operations led to satisfactory repair of both conditions without serious complications. All parents and children were satisfied with the postoperative appearance of the chests.

Conclusions: By choosing the correct operative approach based on patient characteristics, simultaneous elective repair of PE and concurrent CHD is safe and effective, avoids the risk of multiple staged operations and achieves satisfactory outcomes.

Keywords: Congenital heart disease; Nuss procedure; Pectus excavatum; Simultaneous repair.