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  • Case Report
  • Open Access

Pectus excavatum and chest pain: a case report

Cases Journal20081:351

  • Received: 03 July 2008
  • Accepted: 25 November 2008
  • Published:



Simultaneous repair of pectus deformities and open heart surgery has been reported.

Case Presentation

We describe a case of a 23 year old male with a severe pectus deformity complaining of chest pain. Subsequent work up revealed a 10 cm. ascending aortic aneurysm and severe aortic insufficiency. We opted to repair the aneurysm and close the sternotomy, leaving the deformity intact.


In a more elective setting, simultaneous pectus repair combined with a cardiac procedure may be considered.


  • Aortic Aneurysm
  • Cardiac Procedure
  • Pectus Excavatum
  • Aortic Root Replacement
  • Elective Setting


Simultaneous repair of pectus deformities and open heart surgery has been reported. Controversy exists regarding the repair of the pectus deformity at the time of the cardiac procedure.

Case presentation

A 23 year-old Hispanic male, with no prior medical history, presented to the emergency department with a two-week history of increasing chest pain. His physical examination revealed a significant pectus excavatum deformity (Figure 1) and a diastolic murmur. Other physical findings were suggestive of Marfan's disease. He denied alcohol or tobacco use. An abnormal chest x-ray prompted further work up with a CT scan that demonstrated leftward displacement of the heart and great vessels, as well as 10 cm ascending aortic aneurysm (Figure 2). An echocardiogram confirmed severe aortic valve insufficiency. The patient underwent aortic root replacement and aneurysm repair with a valved conduit. An operative photograph exhibits the large ascending aneurysm and a normal appearing distal ascending aorta (Figure 3). The patient made an uneventful postoperative recovery.
Figure 1
Figure 1

Pectus excavatum deformity. Physical examination of the patient demonstrating a pectus excavatum deformity.

Figure 2
Figure 2

CT scan. CT scan demonstrating a 10 cm ascending aortic aneurysm. The surrounding vascular structures are labelled. Note the leftward displacement of the mediastinal structures secondary to the pectus deformity.

Figure 3
Figure 3

Operative photograph. Intra-operative photograph demonstrating the large ascending aortic aneurysm prior to repair. The distal ascending aorta is noted to be normal.


There are numerous case reports documenting simultaneous repair of cardiovascular disorders and correction of pectus deformities [16]. In the above case, we opted to close the sternotomy and leave the deformity intact. The patient stated he had no previous problems related to his deformity and no desire for pectus repair. This decision was facilitated by the potential risk of wound complications in the setting of a newly placed synthetic graft used for the aortic root replacement.


In a more elective setting, simultaneous pectus repair combined with a cardiac procedure may be considered.



Authors’ Affiliations

Division of Plastic and Reconstructive Surgery, University of Southern California Keck School of Medicine, 1510 San Pablo Street, suite 415, Los Angeles, CA 90033, USA
University of Southern California Keck School of Medicine, Cardiovascular and Thoracic Institute, 1520 San Pablo Street, suite 4300, Los Angeles, CA 90033, USA


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© Kim and Baker; licensee BioMed Central Ltd. 2008

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