Cardiac perforation during minimally invasive repair of pectus excavatum: a rare complication

Simone Oliver Senica; Paolo Gasparella; Ksenija Soldatenkova; Lauris Smits; Zane Ābola

doi:10.1093/jscr/rjac538

Cardiac perforation during minimally invasive repair of pectus excavatum: a rare complication

J Surg Case Rep. 2022 Nov 26;2022(11):rjac538. doi: 10.1093/jscr/rjac538. eCollection 2022 Nov.

Authors

Simone Oliver Senica¹, Paolo Gasparella², Ksenija Soldatenkova³, Lauris Smits⁴, Zane Ābola^{3

5}

Affiliations

¹ Faculty of Medicine, Riga Stradins University, Riga 1007, Latvia.
² Department of Pediatric and Adolescent Surgery, Medical University of Graz, Graz 8036, Austria.
³ Department of Pediatric Surgery, Children's Clinical University Hospital, Riga 1004, Latvia.
⁴ Department of Heart Surgery, Children's Clinical University Hospital, Riga 1004, Latvia.
⁵ Department of Pediatric Surgery, Riga Stradins University, Riga 1007, Latvia.

Abstract

Life-threatening complications (LTCs) and negative results of surgical treatments often go unreported. Minimally invasive repair of pectus excavatum (MIRPE) represents a procedure with a low incidence of adverse outcomes. However, 15 potentially fatal cases of MIRPE-related heart injury have been published. We report a case of cardiac perforation (CP) during MIRPE. A 12-year-old female was admitted for elective repair of a severe asymmetric pectus excavatum. Preoperative computed tomography showed a Haller index of 4.9. MIRPE was performed under bilateral video-assisted thoracoscopy. After the placement of the pectus bar, cardiac arrhythmias, hypotension and bilateral hemothorax occurred. Emergency thoracotomy without pectus bar removal showed CP. The wound sites were repaired and the pectus bar was eventually successfully implanted. The patient was discharged on postoperative day 11. After 10 months, she remains asymptomatic. Reporting rare complications is essential for accurate calculations of the true prevalence of LTCs, maintaining high alertness in pediatric surgeons.

Keywords: Nuss procedure; funnel chest; heart injury.

Publication types

Case Reports