Ravasin Alice, Viggiano Domenico, Tombelli Simone, Checchi Luca, Stefàno Pierluigi, Voltolini Luca, Gonfiotti Alessandro
Thoracic Surgery Unit, Careggi University Hospital, 50134 Florence, Italy.
Arrhythmia Unit, Careggi University Hospital, 50134 Florence, Italy.
Life (Basel). 2024 Dec 11;14(12):1643. doi: 10.3390/life14121643.
Pectus excavatum (PE) can be associated with either congenital or acquired heart disease. This study highlights the importance of PE surgical repair in cases of severe chest depression on the heart in underlying cardiac diseases exacerbating cardiopulmonary impairment. From January 2023 to March 2024, four male patients underwent PE repair, having heart disease including pericarditis, mitral valve prolapse, ventricular fibrillation arrest and type 1 second-degree atrioventricular block. PE severity was determined by the Haller index (HI). Preoperative assessment included a pulmonary function test, chest computed tomography and cardiac evaluation. The Nuss procedure was performed in three patients, whereas, in one patient, it was performed in combination with a modified Ravitch procedure. The median HI was five. The median time of chest tube removal was 6.5 days. Postoperative complications were prolonged air leak, atrial fibrillation and atelectasis. The median length of hospital stay was 19.5 days, and no 30-day postoperative mortality was recorded. In all patients, surgical repair helped to resolve the underlying cardiological issues, and surgical follow-ups were deemed regular. PE is generally an isolated congenital chest wall abnormality, and, when associated with a heart disease, it can have severe life-threatening hemodynamic consequences due to mechanical compression on the heart for which surgical corrections should be considered.
漏斗胸（PE）可能与先天性或后天性心脏病相关。本研究强调了在潜在心脏病导致心脏严重受压并加重心肺功能损害的情况下，PE手术修复的重要性。2023年1月至2024年3月，四名男性患者接受了PE修复手术，他们患有包括心包炎、二尖瓣脱垂、心室颤动骤停和I型二度房室传导阻滞在内的心脏病。PE的严重程度由哈勒指数（HI）确定。术前评估包括肺功能测试、胸部计算机断层扫描和心脏评估。三名患者接受了努斯手术，而一名患者则将其与改良的拉维奇手术联合进行。HI的中位数为5。胸腔引流管拔除的中位时间为6.5天。术后并发症包括持续漏气、心房颤动和肺不张。住院时间的中位数为19.5天，术后30天无死亡记录。在所有患者中，手术修复有助于解决潜在的心脏问题，手术随访情况良好。PE通常是一种孤立的先天性胸壁异常，当与心脏病相关时，由于心脏受到机械压迫，可能会产生严重的危及生命的血流动力学后果，对此应考虑进行手术矫正。
