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Case Reports
. 2024 Mar 7;12(3):e8650.
doi: 10.1002/ccr3.8650. eCollection 2024 Mar.

Post-operative arrest following pectus excavatum repair: A case report with a systematic review of the published case reports

Ghazal Roostaei  1 , Hesam Amini  2 , Hamidreza Abtahi  1 , Hossein Kazemizadeh  1 , Maryam Edalatifard  1 , Besharat Rahimi  1 , Sanaz Asadi  1 , Niloofar Khoshnam-Rad  1
Affiliations
Case Reports

Post-operative arrest following pectus excavatum repair: A case report with a systematic review of the published case reports

Ghazal Roostaei et al. Clin Case Rep. .

Abstract

Key clinical message: Common complications after PE surgery include ventricular tachycardia, cardiac arrest, pneumothorax, and bar displacement. These can lead to severe outcomes, emphasizing the need for caution and meticulous post-operative monitoring. Patients and their families should be well-informed about potential risks during the consent process.

Abstract: The objective of this study was to raise awareness among medical staff and surgeons about potential complications, particularly rare and life-threatening ones, associated with pectus excavatum (PE) surgery. PE is the most common chest wall deformity, characterized by sternal depression. Patients primarily seek treatment for cosmetic concerns, but some also report exercise intolerance and shortness of breath. Although surgical repair is the standard treatment, the incidence and nature of severe complications remain unclear and underreported. This study presents a case of a lethal cardiac event following PE surgery and conducts a systematic review of published case reports. This study describes a case of a lethal complication of ventricular fibrillation and cardiac arrest following the Ravitch procedure for correction of PE in a 10-year-old boy. A systematic review of relevant cases of PE surgery complications was conducted. Of the 506 initial records retrieved, 93 case reports from 83 articles were identified over the 23 years. Among them, 72 patients were male, and 20 cases were female. The average age of patients was 19.2 ± 7.7 years (range: 5-53). Complications had occurred up to 37 years from the time of surgery, with most of the cases (22.5%) occurring during the operation. The most frequent complications included cardiothoracic issues and displacement of the implanted steel bar. In nine patients, complications led to fatal outcomes. Due to the possible risks of PE surgery, particularly in cosmetically motivated cases, surgeons must exercise extreme caution and remain vigilant for rare and potentially life-threatening complications.

Keywords: cardiac arrest; complication; death; pectus excavatum; surgery; systematic review.

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Conflict of interest statement

We wish to confirm that there are no known conflicts of interest associated with this work.

Figures

FIGURE 1
FIGURE 1
Preoperative posteroanterior (PA) and lateral chest X‐ray views.
FIGURE 2
FIGURE 2
Before (A) and after (B) surgery photos of the patient.
FIGURE 3
FIGURE 3
Postoperative chest X‐ray.
FIGURE 4
FIGURE 4
PRISMA diagram.
See this image and copyright information in PMC

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