Echocardiographic diagnosis of right ventricular inflow compression associated with pectus excavatum during spinal fusion in prone position.
BACKGROUND
Pectus excavatum is commonly viewed as a benign condition. Associated alterations in hemodynamics are rare. We present an unusual case of right ventricular inflow obstruction and hemodynamic compromise as a consequence of pectus excavatum encountered during surgical intervention.


METHODS
a 15-year-old male with pectus excavatum and thoracolumbar scoliosis developed severe hypotension after induction of general anesthesia and placement in the prone position for elective spinal fusion. A transesophageal echocardiogram revealed anterior compression of the right heart by the sternum with peak and mean right ventricular inflow gradients of 7 and 4 mm Hg, respectively. The gradient resolved with supine positioning and was reproduced with direct compression of the sternum.


CONCLUSIONS
Although pectus excavatum is generally a benign condition, the cardiologist should be aware of the potential for serious hemodynamic compromise related to positioning in these patients.
Galas
James M
JM
Pediatrics Cardiology, University of Michigan Health System, MI, USA. jgalas@med.umich.edu
van der Velde
Mary E
ME
Chiravuri
S Devi
SD
Farley
Frances
F
Parra
David
D
Ensing
Gregory J
GJ
D000293:Adolescent; D018618:Echocardiography, Doppler, Color; D017548:Echocardiography, Transesophageal; D005660:Funnel Chest / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D006439:Hemodynamics; D006801:Humans; D007022:Hypotension / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D008159:Lumbar Vertebrae; D008297:Male; D016684:Prone Position; D012600:Scoliosis / Q000150:complications; D013123:Spinal Fusion; D013249:Sternum / Q000000981:diagnostic imaging; D016683:Supine Position; D013904:Thoracic Vertebrae; D016896:Treatment Outcome; D014694:Ventricular Outflow Obstruction / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology