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Abstract
BackgroundCardiac arrest is a lethal complication of Nuss repair of pectus excavatum which is strongly related to heart or big vessels injury. A rare case developed cardiac arrest without direct cardiac injury during Nuss procedure is presented in this article.Case PresentationIn July 2015, a previously healthy 18-year-old man undergoing Nuss repair for pectus excavatum developed cardiac arrest while the Nuss bar was being inserted into the chest. After successful resuscitation and exclusion of direct cardiac injury, the Nuss procedure was continued. The patient suffered a second cardiac arrest during rotation of the Nuss bar. This time, the patient had poor initial response to resuscitation and defibrillation until the retrosternal bar was removed. He ultimately recovered well from the episodes of cardiac arrest, but was unable to receive surgical correction of his pectus excavatum deformity.ConclusionsThe possible mechanisms of cardiac arrest and lessons we can learn from this complication are discussed.
Highlights
Cardiac arrest is a lethal complication of Nuss repair of pectus excavatum which is strongly related to heart or big vessels injury
The possible mechanisms of cardiac arrest and lessons we can learn from this complication are discussed
Though physical cardiac injury was largely avoided in this case, cardiac arrest still occurred during the procedure
Summary
The Nuss repair of pectus excavatum is a well-established procedure [1]. To prevent damage to the heart and great vessels, thoracoscopy guided method, assisted subxiphoid incision and other minimally invasive techniques have been employed in this procedure [2]. Though physical cardiac injury was largely avoided in this case, cardiac arrest still occurred during the procedure. The patient underwent a modified extrapleural Nuss procedure with a subxiphoid incision [2]. Considering the high possibility of physical cardiac injury given the patient’s response, the Nuss bar was immediately removed, and cardiopulmonary resuscitation (CPR) was performed. Tension pneumothorax and cardiac injury with bilateral thoracoscopes, the Nuss procedure was attempted again. This time, the Nuss bar was successfully pulled through the sternum with the guidance of the introducer, and the patient’s vital signs remained stable. Considering the patient’s serious cardiac insufficiency, the surgery was terminated, and the patient was transferred to the intensive care unit. The patient was discharged without further complication
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