title: [Correction of the complicated pectus excavatum with extracorporeal circulation (ECC) support].
abstract: BACKGROUND
  The most serious complication in surgery of the pectus excavatum is the possible cardiac perforation. After its resolution, it is very likely that the relapse of the excavatum will be more severe due to the intense retrosternal fibrosis generated, involving cardiac structures and fixing them to the sternum. Reintervention requires modifications of the usual techniques and special monitoring due to the increased risk of cardiac and large vessel lesions. We present the case of 2 patients with severe pectus excavatum with a previous attempt for correction with cardiac perforation.
  
  
  METHODS
  Case 1. A 16 year old male with Haller index 9.9, diagnosed of Ehlers-Danlos syndrome and operated on in neonatal period of cardiac disease, with previous attempt for correction using the Ravitch technique that relapsed and cardiac perforation during it. Case 2. An 11 year old girl, with background of diaphragmatic hernia and cardiac perforation on introducing the Nuss bar at 5 years of age, with Haller index 5.5. Both were operated on under ECC with the collaboration of the Cardiac Surgery Service and cardiac adherences were released after median sternotomy. After it, the Nuss bar was introduced and then sternal closure was performed with reinforced steel wires with titanium plates in the anterior and posterior part.
  
  
  CONCLUSIONS
  The backgrounds of the cardiac approach complicate the intervention for the correction of the pectus excavatum, with a high risk of cardiac trauma. Counting on the support of the cardiac surgery and the ECC, we achieve an adequate control and prediction of the complications
authors.affiliation: Servicio de Cirugía Pediátrica, Departamento de Cirugía Pediátrica, Hospital Universitario la Paz, Madrid. shernandezm.hulp@salud.madrid.org
authors.forename: S
authors.initials: S
authors.lastname: Hernández
authors.forename: A
authors.initials: A
authors.lastname: Fernández
authors.forename: M
authors.initials: M
authors.lastname: Ramírez
authors.forename: S
authors.initials: S
authors.lastname: López
authors.forename: C A
authors.initials: CA
authors.lastname: De la Torre
authors.forename: M
authors.initials: M
authors.lastname: Miguel
authors.forename: M
authors.initials: M
authors.lastname: Bret
authors.forename: A
authors.initials: A
authors.lastname: Aroca
authors.forename: P
authors.initials: P
authors.lastname: Olivares
authors.forename: J A
authors.initials: JA
authors.lastname: Tovar
mesh_terms: D000293:Adolescent; D002648:Child; D005112:Extracorporeal Circulation; D005260:Female; D005660:Funnel Chest / Q000150:complications / Q000601:surgery*; D006335:Heart Injuries / Q000209:etiology / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology / Q000601:surgery; D008297:Male; D012008:Recurrence; D012720:Severity of Illness Index