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Repair of Both Severe Pectus Excavatum Deformity and Ascending Aortic Root Aneurysm

Wednesday, September 14, 2016

Originally presented as a Surgical Motion Picture at the 2015 STSA Annual Meeting

Objectives: A 23-year-old male patient presented with dyspnea, chest pain, and fatigue for three days. He had no cough, fever, or myalgias. He had a family history of aortic aneurysms. An exam revealed a pectus excavatum deformity. According to the Haller index, the deformity was severe. A CT scan of the chest was performed which showed a 5.5 cm aortic root aneurysm.

Methods: The pectus excavatum and aortic root aneurysm were repaired concurrently. A modified Ravitch procedure was performed for the pectus repair. Costal cartilage was removed from the third to the eighth rib. Prior to stabilizing the sternum, the chest cavity was entered at 2.5 cm lateral and to the left of the sternum. The left internal mammary artery was preserved. The aortic root was replaced with a composite graft. The sternum was fractured transversely at the manubrium and displaced anteriorly with titanium plates.

Results: The patient was extubated within six hours of surgery. The pleural and pericardial drains were removed on the second and third days after surgery. The subcutaneous drains were removed by the sixth postoperative day. On the seventh postoperative day, the patient was discharged home. At the nine month follow-up the patient is doing well and pleased with the cosmetic results of the pectus repair.

Conclusion: This is a unique case of concurrent pectus excavatum repair and ascending aortic root replacement. The modified approach to the pectus repair with titanium plates is also original. This is one of very few reported cases of both an aortic root replacement and severe pectus excavatum repair.

Copyright 2015, used with permission from the Southern Thoracic Surgical Association. All rights reserved.


Excellent work. Congratulations. I had the opportunity to perform a 6.5 cm aortic root and ascending aneurysm in a young Marfan lady who had two previous failed pectus repairs as an adolescent that had not restored her chest wall anatomy. Due to dense chest wall scarring and distortion of the chest wall it proved to be challenging. She is doing well on 2 years follow up. Your approach is a very useful learning point in Virgin chests with severe pectus and aortic aneurysm as these patients are usually young Marfan cases.

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