Congenital Chest Wall Defects

Catastrophic cardiac injuries encountered during the minimally invasive repair of pectus excavatum

This paper presents four severe cardiac injuries that occurred in patients who underwent the minimally invasive repair of pectus excavatum (MIRPE). These complications occurred in different clinical settings, namely in a patient with an extremely severe form of pectus, in a patient who had previously undergone an open repair, after a previous open heart surgery, and at the time of bar removal. The purpose of this article is to review the circumstances leading to these cardiac injuries, share what we have learned from these patients, and hopefully help avoid these complications in the future.

Chest pain and chest wall deformity

Chest pain and chest wall deformities are common in children. Although most children with chest pain have a benign diagnosis, some have a serious etiology for pain, so the complaint must be addressed carefully. Unfortunately, there are few prospective studies to evaluate this complaint in children. Serious causes for chest pain are rare, making it difficult to develop clear guidelines for evaluation and management. The child who appears well, has a normal physical examination, and lacks worrisome history deserves reassurance and careful follow-up rather than extensive studies. Multicenter studies are needed to better define this important symptom.

Cardiac perforation by a pectus bar after surgical correction of pectus excavatum: case report and review of the literature

Pectus excavatum (PE) is a congenital sternal depression. The two most popular methods of correction are the highly modified Ravitch repair (HMRR) and the Nuss procedure. Presented here is a case of PE surgical correction in a 17.5-year-old male, beginning with the Nuss technique and converting to the HMRR during surgery, due to unsatisfying results. The procedure inadvertently culminated in perforation of the heart and lungs by the inserted pectus bar, with aggravation of the damage by resuscitation efforts. This article analyzes the chain of events leading to the patient's death and reviews the literature on the subject.