Simultaneous surgical strategy for pectus excavatum and concurrent congenital heart defects in children

Objective To explore the optimal surgical strategy for children with pectus excavatum (PE) and concurrent congenital heart defect (CHD). Methods From July 2007 to May 2018, retrospective reviews were conducted for medical records of 17 children undergoing simultaneous repair of PE with concurrent CHD.There were 10 boys and 7 girls with an average age of (4.5±2.7)(1-12.7) years and an avergae body weight of (14.5±5.2)(7.5-27.5) kg.There were simple ventricular septum defect (VSD, n=4), simple atrial septum defect (ASD, n=8), VSD & ASD (n=3), VSD & ASD & patent ductus arteriosus (PDA, n=1) and VSD with pulmonary hypertension (n=1). For repairing PE, open sternal elevation was performed with liberating tissue from posterior sternum, lifting sternum by wires, Nuss plating and a custom-made sternal lifting device.CHD was corrected by open heart surgery via cardiopulmonary bypass or transcatheter closure under echocardiography or radiology-guided percutaneous intervention. Results Among them, the operations led to satisfactory repair of both conditions without serious complications.All parents and children were satisfied with postoperative chest appearances.The mean duration of hospitalization was (13.6±4.8)(8-25) days.The postoperative complications were delayed wound healing (n=2) and minimal left pleural effusion (n=1). There was no occurrence of such severe complications as surgical mortality, major hemorrhage, chest organ injuries or implant rejection. Conclusions According to the characteristics of patients, individualized approaches are selected for correcting PE and concurrent CHD.Both safe and effective, such a strategy avoids the risks of multiple operations and anesthesia and the outcomes are satisfactory. Key words: Funnel chest; Heart diseases, congenital; Child