Hybrid repair of pectus excavatum and congenital heart disease

RATIONALE Pectus excavatum (PE) in the setting of congenital heart disease is not uncommon. The surgical strategy has evolved over the last 20 years from a staged approach to simultaneous repair of both defects. PATIENT CONCERNS A 3-year-old boy was admitted for elective repair of PE and atrial septal defect (ASD). DIAGNOSES Clinically, there were obvious features of PE and a grade 2 systolic murmur heard loudest at the 2nd intercostal space abutting the left sternal border. Echocardiography confirmed the presence of a secundum-type ASD. Following discussions with the family, consent was obtained and the patient underwent concomitant surgery for both defects. The ASD was first device-closed under the guidance of transesophageal echocardiography (TEE) and then a standard Nuss procedure was performed with an 8-inch bar. OUTCOMES Postoperative echocardiography confirmed a satisfactory device closure of the ASD. The repair of PE was considered satisfactory on physical examination and with chest radiography. The postoperative course was uneventful except for atelectasis of the right upper lobe. The patient was discharged 10 days postoperatively. LESSONS This case suggests that in carefully selected cases with concomitant PE and ASD, a combination of Nuss procedure and TEE-guided transcatheter device closure can be safely performed with less physical and no radiation trauma and theoretically better aesthetic effects and surgical outcome.