Modified Nuss Procedure in Concurrent Repair of Pectus Excavatum and Open Heart Surgery

Simultaneous repair of pectus excavatum and pulmonary valve implantation years after complete repair of tetralogy of Fallot

“…The simultaneous correction includes an increased incidence of complications such as bleeding, infection and untoward effects of long operation times [1,7]. It is reported that when the CHD is repaired without any intervention for PE, inadequate intraoperative exposure and postoperative mediastinal compression may severely compromise the hemodynamics after the intracardiac repair [2][3][4][5]. In our patient, both the cardiac compression and pulmonary valve regurgitation were severe which prohibited a staged approach.…”

“…The titanium bars connect the reciprocal ribs at the each side of the sternum, which is closed with steel wires at the end of the operation (dotted lines the segments of the titanium bars crossing behind the sternum) (c) may also possess untoward effects with regard to wound healing in severely cyanotic children [2]. Casamassima and colleagues recommend that the decision to perform a single-versus a multiple-stage procedure should be reserved until after the cardiac procedure has been completed during the operation [4]. They evaluated each patient in their series of 9 patients with Nuss procedure and they decided whether to repair PE or not after the evaluation of cardiopulmonary bypass time and blood loss [4].…”

“…Casamassima and colleagues recommend that the decision to perform a single-versus a multiple-stage procedure should be reserved until after the cardiac procedure has been completed during the operation [4]. They evaluated each patient in their series of 9 patients with Nuss procedure and they decided whether to repair PE or not after the evaluation of cardiopulmonary bypass time and blood loss [4]. To the best of our knowledge, our patient is the first patient in the literature that deemed the third sternotomy necessary with PE repair.…”

“…The incidence of PE in CHD patients is reported to be between 0.17 and 11.6 % [1, 2, 6]. Although the minimal invasive approach popularized by Nuss and colleagues is used in PE patients [4], the Ravitch procedure is considered to be superior by some authors, especially when concomitant open heart surgery is performed with midline sternotomy [8]. Cartilage resection performed before the correction of the cardiac defect provides easier manipulation of the thoracic cavity with an improved visualization of the operative field [6].…”

“…In up to 0.8-1.5 % of PE patients, there are additional congenital cardiac diseases [1]. Although traditional approach had aimed to repair the different malformations in separate surgical interventions, there are growing number of reports that advocate simultaneous repair [2][3][4][5]. Herein, we present a patient who underwent redo open heart surgery for pulmonary valve implantation years after complete repair of tetralogy of Fallot (TOF) along with repair of PE.…”