Skip to main content

Advertisement

Pectus excavatum and chest pain: a case report

Article metrics

Abstract

Background

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.

Conclusion

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

Background

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
figure1

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

Figure 2
figure2

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
figure3

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

Discussion

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.

Conclusion

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

Consent

"Written informed consent was obtained from the patient for publication of this case report and accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal."

References

  1. 1.

    Aoyagi S, Fukunaga S, Arinaga K, et al: Simultaneous repair of cardiovascular disorders and pectus deformity in a patient with Sprintzen-Goldberg syndrome: A case report. Ann Thorac Cardiovasc Surg. 1999, 5 (6): 411-4.

  2. 2.

    Ichikawa S, Miyata Y, Usui M, et al: Single-stage surgery for annulo aortic ectasia, Stanford type-A dissection and pectus excavatum in a patient with Marfan's syndrome. Nippon Kyobu Geka Gakkai Zasshi. 1996, 44 (4): 575-579.

  3. 3.

    Chien HF, Chu SH: Simultaneous Bentall's procedure and sternal turnover in a patient with Marfan syndrome. J Cardiovasc Surg (Torino). 1995, 36 (6): 559-562.

  4. 4.

    Correction of pectus excavatum combined with open heart surgery in patient with Marfan's syndrome. Thorac Cardiovasc Surg. 1995, 43 (4): 220-2. 10.1055/s-2007-1013215.

  5. 5.

    Tschirkov A, Natschev G, Mishev B, Savova A, Ovanessjan H: An easy and safe approach for simultaneous repair of severe pectus excavatum and the underlying lesions of the heart and thoracic aorta. J Thorac Cardiovasc Surg. 1989, 98 (2): 305-7.

  6. 6.

    Miller DR, Pugh DM: Repair of ascending aortic aneurysm and aortic regurgitation complicated by acute cardiac compression by pectus excavatum in Marfan's syndrome. J Thorac Cardiovasc Surg. 1970, 59 (5): 673-84.

Download references

Author information

Correspondence to Craig J Baker.

Additional information

Competing interests

The authors declare that they have no competing interests.

Authors' contributions

RK and CB equally contributed to the preparation of this manuscript. RK and CB both approved the final manuscript.

Authors’ original submitted files for images

Below are the links to the authors’ original submitted files for images.

Authors’ original file for figure 1

Authors’ original file for figure 2

Authors’ original file for figure 3

Rights and permissions

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Reprints and Permissions

About this article

Cite this article

Kim, R.Y., Baker, C.J. Pectus excavatum and chest pain: a case report. Cases Journal 1, 351 (2008) doi:10.1186/1757-1626-1-351

Download citation

Keywords

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