title: Eyes wide shut--unusual two stage repair of pectus excavatum and annuloaortic ectasia in a 37 year old marfan patient: case report.
abstract: We report about a 37 year old male patient with a pectus excavatum. The patient was in NYHA functional class III. After performed computed tomography the symptoms were thought to be related to the severity of chest deformation. A Ravitch-procedure had been accomplished in a district hospital in 2009. The crack of a metal bar led to a reevaluation 2010, in which surprisingly the presence of an annuloaortic ectasia (root 73×74 mm) in direct neighborhood of the formerly implanted metal-bars was diagnosed. Echocardiography revealed a severe aortic valve regurgitation, the left ventricle was massively dilated presenting a reduced ejection fraction of 45%. A marfan syndrome was suspected and the patient underwent a valve sparing aortic root replacement (David procedure) in our institution with an uneventful postoperative course. A review of the literature in combination with discussion of our case suggests the application of stronger recommendations towards preoperative cardiovascular assessment in patients with pectus excavatum.
authors.affiliation: Department of Cardiovascular Surgery, Hospital Clínic, University of Barcelona, Barcelona, Spain. mgrapow@uhbs.ch
authors.forename: Martin T R
authors.initials: MT
authors.lastname: Grapow
authors.forename: Paula
authors.initials: P
authors.lastname: Campelos
authors.forename: Clemente
authors.initials: C
authors.lastname: Barriuso
authors.forename: Jaume
authors.initials: J
authors.lastname: Mulet
mesh_terms: D000015:Abnormalities, Multiple; D000328:Adult; D017545:Aortic Aneurysm, Thoracic / Q000151:congenital / Q000175:diagnosis / Q000601:surgery*; D001018:Aortic Diseases / Q000151:congenital / Q000175:diagnosis / Q000601:surgery*; D017548:Echocardiography, Transesophageal; D004562:Electrocardiography; D005500:Follow-Up Studies; D005660:Funnel Chest / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D008382:Marfan Syndrome / Q000175:diagnosis / Q000601:surgery*; D019637:Orthopedic Procedures / Q000379:methods*; D014057:Tomography, X-Ray Computed; D014656:Vascular Surgical Procedures / Q000379:methods*