title: Modified nuss procedure in concurrent repair of pectus excavatum and open heart surgery.
abstract: BACKGROUND
  Pectus excavatum (PE) can be associated with congenital and acquired cardiac disorders that also require surgical repair. The timing and specific surgical technique for repair of PE remains controversial. The present study reports the experience of combined repair of PE and open heart surgery at Johns Hopkins Hospital.
  
  
  METHODS
  A retrospective case review was conducted of all patients who presented for repair of PE deformity while undergoing concurrent open heart surgery from 1998 through 2011.
  
  
  RESULTS
  A total of 9 patients met inclusion criteria. All patients had a connective tissue disorder. Repair of PE was performed by modified Nuss technique after completion of the cardiac procedure, performed through a median sternotomy. Open heart procedures were either aortic root replacement or mitral valvuloplasty. Eight patients had bar removal after an average period of 30.3 months. No PE recurrence, bar displacement, or upper sternal depression was reported in 7 patients. Postoperatively, 1 patient exhibited pectus carinatum after a separate spinal fusion surgery for scoliosis. One patient died of unrelated cardiac complications before bar removal.
  
  
  CONCLUSIONS
  Simultaneous repair of PE and open heart surgery is safe and effective. We recommend that the decision to perform a single-stage versus a multistage procedure should be reserved until after the cardiac procedure has been completed. In such cases, the Nuss technique allows for correction of the pectus deformity with good long-term cosmetic and functional results.
authors: Center for Pediatric Surgical Clinical Trials and Outcomes Research, Division of Pediatric Surgery, Baltimore, MD 21287, USA.
authors: Maria Grazia
authors: MG
authors: Sacco Casamassima
authors: Ling Ling
authors: LL
authors: Wong
authors: Dominic
authors: D
authors: Papandria
authors: Fizan
authors: F
authors: Abdullah
authors: Luca A
authors: LA
authors: Vricella
authors: Duke E
authors: DE
authors: Cameron
authors: Paul M
authors: PM
authors: Colombani
mesh_terms: D000293:Adolescent; D000328:Adult; D006348:Cardiac Surgical Procedures / Q000379:methods*; D005260:Female; D005660:Funnel Chest / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006331:Heart Diseases / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D056346:Sternotomy / Q000379:methods*; D013249:Sternum / Q000601:surgery*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult