Pediatric Surgery International (2018) 34:269–275
Simultaneous repair of congenital heart defects and pectus excavatum
in young children
· Quan Wang
· Zhengxia Pan
Accepted: 18 December 2017 / Published online: 5 January 2018
© Springer-Verlag GmbH Germany, part of Springer Nature 2018
Purpose The present study was undertaken to summarize our experience with the concurrent repair of pectus excavatum
(PE) and congenital heart defects in young children over the past 15 years.
Methods A retrospective study was conducted that included patients who underwent combined repair of PE and a congeni-
tal heart defect in a large clinical center between 2002 and 2017. Intraoperative and postoperative patient characteristics,
postoperative complications and surgical outcomes were recorded.
Results Twenty-one patients met the inclusion criteria. An open heart surgery and a modiﬁed sternal elevation with anterior
sternal suspension were performed. No intraoperative complications occurred. Postoperatively, three patients developed
pneumonia, two patients developed subcutaneous eﬀusions, one patient sustained an asymptomatic pneumothorax, and
one other patient had a transitory fever. In all cases, postoperative recovery was uneventful, and no perioperative mortality
occurred. Bar removal was performed in 19 patients at an average of 2.55 years postoperatively: 18 of them achieved an
excellent outcome, and 1 patient had a good ﬁnal result.
Conclusion A combined procedure of modiﬁed sternal elevation and cardiac repair may be performed safely in young chil-
dren. Early repair of PE is feasible and eﬀective in these patients.
Keywords Pectus excavatum · Congenital heart defect · Children · Simultaneous repair · Sternal elevation
Pectus excavatum (PE) is the most common congenital
deformity of the chest wall and usually presents as an iso-
lated congenital abnormality. In rare cases, PE may also be
associated with a congenital heart defect. The co-existence
of PE and a congenital heart defect that both require surgi-
cal intervention poses a signiﬁcant challenge for surgeons.
Currently, no consensus exists regarding the beneﬁts of
performing a simultaneous repair versus a staged procedure
to address this condition. Most surgeons prefer a two-stage
repair due to concerns about concurrent procedures, such as
prolonged operating time, increased bleeding, wound infec-
tion, and sternal dehiscence. Though many sporadic cases of
combined procedures have been reported to provide optimal
cosmetic and functional outcomes, only a limited number of
case series have been published. Furthermore, present stud-
ies have mostly focused on adults and older children, with
particularly rare reports of younger children with combined
PE and congenital cardiac defects.
In this study, we reviewed our experience with 21 young
children, including infants and toddlers, who underwent con-
comitant repair of both PE and an intracardiac defect over
the past 15 years in a large clinical center to further inves-
tigate the feasibility and eﬀectiveness of such a combined
procedure in this young patient population.
* Zhengxia Pan
Department of Cardiovascular and Thoracic Surgery,
Children’s Hospital of Chongqing Medical University,
Chongqing 400014, China
Pediatric Research Institute, Children’s Hospital
of Chongqing Medical University, Chongqing 400014, China
Chongqing Key Laboratory of Pediatrics, Ministry
of Education Key Laboratory of Child Development
and Disorders, China International Science and Technology
Cooperation Base of Child Development and Critical
Disorders, Chongqing 400014, China