Catastrophic cardiac injuries encountered during the minimally invasive repair of pectus excavatum

Life-Threatening Hemorrhage During Removal of a Nuss Bar Associated With Sternal Erosion

“…Removal of the bars is recommended 2 to 3 years after implantation. Bleeding during bar removal secondary to aortic, pulmonary, or cardiac injury has been previously reported [1][2][3]. We present a case of life-threatening hemorrhage during removal of a bar associated with sternal erosion.…”

Anaesthetic considerations for pectus repair surgery

“…This can be best achieved using the mid oesophageal four chamber view and the right ventricle inflow-outflow view by rotating the probe to 45 degrees. There have been a number of case series reporting feasibility of perioperative TOE during pectus surgery (42,43). These have not only helped the anaesthetist to quantify and document the improvement in right ventricular function but also guide the surgical team in real time when performing retrosternal dissection (44).…”

“…These have not only helped the anaesthetist to quantify and document the improvement in right ventricular function but also guide the surgical team in real time when performing retrosternal dissection (44). After insertion of the pectus bar, a TOE examination may help to identify pericardial/pleural collections, myocardial injury, or any iatrogenic valvular damage (43). A comprehensive examination of the mitral and tricuspid valve should also be performed before and after the procedure to exclude valvular injuries.…”

“…The major intraoperative complications include perforation of the right ventricle and vascular injuries leading to life-threatening haemorrhage. Cardiac perforation, liver perforation, aortic injury, inferior vena cava compression, intercostal artery bleeding have all been described in literature (22,43,(96)(97)(98)(99)(100). These can be proactively monitored with intraoperative TOE.…”

Minimally Invasive Repair of Pectus Excavatum

“…Though complications after MIRPE are fairly rare today, it is important to recognize the impact of the procedural learning curve on declining rates and be aware that these data come from centers with extensive experience in the repair of chest wall deformities. Furthermore, though rare, mortality during or after the procedure has been reported (23). Given that pectus excavatum is a condition that rarely causes any life-threatening problems, it is especially important to educate patients and families on the risks associated with the operation, both bar insertion and removal, through discussion and patient education materials in order to allow all parties to make a calculated, well-informed decision about surgical treatment.…”