Sudden Cardiac Arrest in a Young Patient With Severe Pectus Excavatum

Rachwan, Rayan Jo; Purpura, Andrea; Kahwash, Basil M.

doi:10.1016/j.amjms.2018.06.002

Cited by 6 publications

(5 citation statements)

References 17 publications

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“…A search revealed two case reports on sudden cardiac arrest based on VF in patients with severe pectus excavatum. 5 , 6 Both authors describe management with subcutaneous ICD placement, although Rachwan et al . 6 discuss that this is not supported by evidence.…”

Section: Discussionmentioning

confidence: 99%

“… 5 , 6 Both authors describe management with subcutaneous ICD placement, although Rachwan et al . 6 discuss that this is not supported by evidence. Less severe symptoms (such as lightheadedness when bending over, such as the current patient experienced before the event) are also described.…”

Section: Discussionmentioning

confidence: 99%

“…With respect to VF resulting in cardiac arrest in the presence of severe pectus excavatum, literature is scarce regarding aetiology and management, particularly whether an implantable cardioverter-defibrillator (ICD) should be placed. 5 , 6 …”

Section: Introductionmentioning

confidence: 99%

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Case report: ventricular fibrillation and cardiac arrest provoked by forward bending in adolescent with severe pectus excavatum

Moossdorff

Maesen

Uijl

et al. 2021

European Heart Journal - Case Reports

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Background Life-threatening arrhythmias have been reported in patients with severe pectus excavatum in absence of other cardiac abnormalities. Literature is scarce regarding diagnosis, cause and management of this problem, particularly regarding the question as to whether the placement of an implantable cardioverter-defibrillator (ICD) is necessary. Case summary A 19-year-old male patient with severe pectus excavatum was scheduled for elective surgical correction. During forward bending for epidural catheter placement, syncope and ventricular fibrillation (VF) occurred resulting in cardiac arrest. After successful cardiopulmonary resuscitation, extensive analysis was performed and showed no cause for VF other than cardiac compression (particularly of the left atrium, right atrium, and ventricle to a lesser degree) due to severe pectus excavatum. Postponed correction by modified Ravitch was performed without ICD placement, with an uneventful post-operative recovery. Eighteen months after surgery, the patient remains well. Upon specific request, he did remember dizzy spells when tying shoelaces. He always considered this unremarkable. Discussion In severe pectus excavatum with cardiac compression, forward bending can decrease central venous return and cardiac output, causing hypotension, arrhythmia, and cardiac arrest. In absence of structural or electric abnormalities, cardiac compression by severe pectus excavatum was considered a reversible cause of VF and ICD placement unnecessary. Patients with cardiac compression due to severe pectus excavatum may report pre-existing postural symptoms upon specific request. When these postural symptoms are present, extreme and prolonged forward bending postures should be avoided.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Case report: ventricular fibrillation and cardiac arrest provoked by forward bending in adolescent with severe pectus excavatum

Moossdorff

Maesen

Uijl

et al. 2021

European Heart Journal - Case Reports

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“…His ST-segment morphology was normalized following surgery to fix the thoracic deformity. Sudden cardiac arrests have also been reported in young males with pectus excavatum 18,19 .…”

Section: Relationship Between Thoracic Size and Brsmentioning

confidence: 97%

Narrow Anteroposterior Thorax may be Associated with Brugada Syndrome due to Chronic Mechanical Compression of the Right Ventricular Outflow Tract

Ishii

Nakagawa

Abe

et al. 2020

Preprint

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Introduction: Recent research has shown that Brugada syndrome (BrS) is associated with interstitial fibrosis in the right ventricular outflow tract (RVOT) epicardium, thus suggesting that BrS does not just involve cardiac channelopathy but also includes cardiomyopathy. On the other hand, Brugada pattern ECGs are often observed in patients with pectus excavatum. The purpose of this study was to investigate whether thoracic deformity, along with mechanical compression of RVOT, were associated with BrS. Methods and Results: We recruited 17 male patients with symptomatic BrS, 32 male patients with asymptomatic BrS, and 30 age-matched male controls. Using computed tomography (CT) scans, we measured the maximal internal transverse diameter of the thorax (T) and the shortest anteroposterior depth from the internal aspect of the sternum to the anterior cortex of the vertebral body (D) at the level of the RVOT. We then evaluated the fragmented QRS (f-QRS) in the right precordial leads. D was significantly shorter, while T divided by D (T/D) was significantly greater, in patients with symptomatic and asymptomatic BrS than in the controls. Six patients with pectus excavatum (T/D[?]3.25) were included in the BrS population. The f-QRSs was more frequently observed in symptomatic and asymptomatic BrS patients than in controls. The positive spikes within the QRS complex were more prevalent in patients with a greater T/D. Conclusion: Our results suggested that a narrow anteroposterior thoracic space could be associated with BrS via mechanical compression of the RVOT.

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“…Gastroesophageal reflux may occasionally occur, and, rarely, swallowing may be impaired [3,[11][12][13]. Serious complications such as sudden cardiac arrest as an initial presentation of pectus excavatum are discussed in the literature [14].…”

Section: Introductionmentioning

confidence: 99%

Minimalized Erlangen Correction Method by Hümmer (MEK) Compared with Conventional and Minimally Invasive Correction Methods for Pectus Excavatum Single Center Experience

Denzinger,

Reis Wolfertstetter,

Sossau

et al. 2023

Applied Sciences

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Pectus excavatum (funnel chest) is the most common chest wall deformity in childhood and adolescence with a prevalence in the literature ranging from 1 in 3400 to 1 in 1000. In addition to conservative therapy with a suction cup and physiotherapy to improve posture, fitness, and muscle strength, there are several different surgical techniques, many of which have been improved over time. In evaluating the Minimalized Erlangen Correction Method (MEK), the main purpose of this retrospective analysis is to present the results and to compare them with reports on the Minimally Invasive Repair of Pectus Excavatum (MIRPE) technique, especially regarding long-term patient satisfaction, and with other open surgical methods in terms of operative trauma, as well as flexibility in its application, risk of complications, and patient safety.

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Sudden Cardiac Arrest in a Young Patient With Severe Pectus Excavatum

Cited by 6 publications

References 17 publications

Case report: ventricular fibrillation and cardiac arrest provoked by forward bending in adolescent with severe pectus excavatum

Case report: ventricular fibrillation and cardiac arrest provoked by forward bending in adolescent with severe pectus excavatum

Narrow Anteroposterior Thorax may be Associated with Brugada Syndrome due to Chronic Mechanical Compression of the Right Ventricular Outflow Tract

Minimalized Erlangen Correction Method by Hümmer (MEK) Compared with Conventional and Minimally Invasive Correction Methods for Pectus Excavatum Single Center Experience

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