Refinement of Operative Method for Single-Stage Treatment of Pectus Excavatum and Heart Disease

Simultaneous Aortic Valve Replacement and Pectus Excavatum Correction in a 76-Year-Old Man

“…PE is likely to occur among patients with connective tissue disease such as Marfan syndrome, [5][6][7] but characteristic of Marfan syndrome, such as spider fingers and subluxation of the crystalline lens, was not detected in our case. In adult patients with PE, the clinical picture remains unclear because there are few published reports on the therapeutic management of PE in these patients.…”

“…In contrast, in our case, the total volume of blood loss was 3990 ml, regardless of the shorter CPB duration of 171 min. The modified Ravitch procedure 6) involves preparation of PMM flaps, resection of the deformed costal cartilages, and sternal osteotomy. Blood loss derived from the peeled tissue, including the edges of the costal cartilages and the sternum, may have increased with the use of heparin in our case.…”

“…[3][4][5] Staged operations were formerly recommended; 3) however, single-stage operations have been reported with favorable results in recent years. [4][5][6][7] We decided to perform simultaneous AVR and PE correction using the modified Ravitch procedure 6) to avoid any postoperative cardiopulmonary complications that may result from mechanical compression due to uncorrected sternal deformities. The patient was substantially relieved of his complaint; however, the single-stage operation using the modified Ravitch procedure induced excessive bleeding and a high-volume transfusion secondary to the prolonged operation time and postoperative recovery.…”

“…First, a midline skin incision was made, and a pectoralis major musculocutaneous (PMM) flap and sternum bone (SB) flap with the left internal thoracic artery and vein were prepared as previously described. 6,7) The SB flap was wrapped with wet gauze and turned over the head, resulting in good exposure of the heart. The left coronary cusp of the aortic valve was particularly shrunken, which induced lack of co-adaptation of the valve (Fig.…”

“…In these cases, staged operations were formerly recommended; 3) however, single-stage operations have been reported with favorable results in recent years. [4][5][6][7] In this case report, we present an adult patient who successfully underwent simultaneous aortic valve replacement (AVR) and PE correction using the modified Ravitch procedure and discuss surgical management for PE in adult patients.…”