title: Management of severe asymmetric pectus excavatum complicating aortic repair in a patient with Marfan's syndrome.
abstract: We describe the case of a 28-year old man with Marfan's syndrome and severe pectus excavatum who required an aortic root replacement for an ascending aortic aneurysm. There was a near-vertical angulation of the sternum that presented challenges with opening and exposure of the heart during aortic surgery. Furthermore, removal of the sternal retractor after aortic repair resulted in sudden loss of cardiac output. A Ravitch procedure was then performed to successfully close the chest without further cardiovascular compromise. We propose that patients with a severe pectus excavatum and mediastinal displacement seen on preoperative CT scanning should be considered for simultaneous, elective repair.
authors.affiliation: Division of Thoracic Surgery, St. Joseph's Health Centre, Toronto, ON, Canada.
authors.forename: Jonathan C
authors.initials: JC
authors.lastname: Yeung
authors.affiliation: Department of Radiology, St. Michael's Hospital, Toronto, ON, Canada.
authors.forename: Danny
authors.initials: D
authors.lastname: Marcuzzi
authors.affiliation: Division of Cardiac Surgery, St. Michael's Hospital, Toronto, ON, Canada.
authors.forename: Mark D
authors.initials: MD
authors.lastname: Peterson
authors.affiliation: Division of Thoracic Surgery, St. Joseph's Health Centre, Toronto, ON, Canada komich@stjoe.on.ca.
authors.forename: Michael A
authors.initials: MA
authors.lastname: Ko
mesh_terms: D000328:Adult; D001013:Aorta, Thoracic / Q000000981:diagnostic imaging / Q000601:surgery*; D017545:Aortic Aneurysm, Thoracic / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D002302:Cardiac Output / Q000502:physiology; D017548:Echocardiography, Transesophageal; D005660:Funnel Chest / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D006323:Heart Arrest / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007431:Intraoperative Complications; D008297:Male; D008382:Marfan Syndrome / Q000150:complications*; D012720:Severity of Illness Index; D013905:Thoracoplasty / Q000379:methods*; D014057:Tomography, X-Ray Computed; D014656:Vascular Surgical Procedures / Q000009:adverse effects* / Q000379:methods
keywords: Aortic; Aortic root; Marfan; Pectus excavatum