Abstract
Pectus excavatum is a chest wall malformation with a strong psychological and aesthetic impact. Rarely, pectus excavatum patients can show respiratory or cardiac symptoms occurring mainly during physical exertion. We report a case of a 34-year-old pregnant woman with a severe degree of pectus excavatum who developed serious cardiovascular disease resulting in spontaneous twin abortion at the twenty-first week of gestation. Cardiovascular disease was resolved after open surgical correction of pectus excavatum. This case shows how a tardive diagnosis and a delayed surgical approach for pectus excavatum can lead to severe consequences.
Highlights
We describe a case of a 34-year pregnant woman with a severe degree of pectus excavatum determining heart compression and resulting in a spontaneous twin abortion at the twenty-first week of gestation due to a venous thrombosis
Aesthetic discomfort is the main indication for pectus excavatum correction
The pectus excavatum-related complications are known until decades and clinical presentation can be various
Summary
Pectus Excavatum is the most common deformity of the chest wall [1]. Generally, pectus excavatum has only a strong psychological and aesthetic impact, especially in youth and adolescence, showing alterations of their emotional and behavioral sphere, manifesting a real discomfort with their body and aesthetic appearance. On March 2019, she experienced a spontaneous twin abortion at the 21st week of gestation, probably due to deep vein thrombosis; no autoimmune disorders (negative anticardiolipin and homocysteine antibodies) or coagulopathies were detected She started therapy with direct oral anticoagulants without obtaining a complete resolution of the thrombotic process, as demonstrated by the echo-color Doppler examination of the lower limbs performed after 6 months. The patient was discharged on the fifth postoperative day; a 6-month chest CT showed a further improvement both of Haller index (4.73) and the antero-posterior diameter (59.34 mm) (Fig. 4a, b); the thrombosis was no longer evident at the level of the femoral vein and the patient has discontinued the anticoagulant therapy. Postoperative echocardiography showed a reduction of mitral and pulmonary valve insufficiency with improvement of cardiac function and the inferior vena cava flow was clearly visualized
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