Pectus Excavatum With Hemodynamic Repercussion Corrected by the Cross-Bar Technique With Cryoanalgesia

Pectus excavatum is a thoracic deformity with mainly aesthetic repercussions in mild to moderate cases. However, in more serious cases, it can affect cardiorespiratory function and hemodynamic compromise may occur. The use of different surgical techniques and their approaches to treat this deformity are well known. Depending on the characteristics and severity of the case, it may be necessary to adapt and/or modify classic surgical techniques. The authors present a case of severe pectus excavatum with hemodynamic repercussion corrected using the cross-bar technique and cryoanalgesia for pain management. 
 
The patient was a 37-year-old female high-performance athlete with severe pectus excavatum (HI 3.5) associated with compression of the right cavities, occasional palpitations, and an episode of syncope. The surgical technique used consisted of bilateral cryoanalgesia from levels T3 to T7, sternal elevation with a traction crane, and anchoring of two screws. The cross-bar correction involved the placement of three bars guided by thoracoscopy and the fixation of the three bars with two stabilizer bridges. A flare-buster correction was performed on the associated chondral dysmorphia using a fiberloop suture. Intraoperative transesophageal echocardiography was performed before and after sternal relocation. 
 
Correction of the thoracic deformity was achieved, as well as decompression of the right heart cavities evidenced by the intraoperative echocardiography. The patient did not experience surgical complications in the immediate postoperative period. At the three month examination, the bars were still correctly positioned and the patient had little pain with occasional intake of paracetamol. 
 
The cross-bar technique can be applied successfully in severe cases of pectus excavatum by providing full support of the sternum. The use of a sternal elevation crane facilitates the dissection of the anterior mediastinum, potentially decreasing the risk of bleeding, hemopericardium, and cardiac tamponade. Fixing the bars with stabilizer bridges prevents bar displacement and diminishes the risk of costal erosion. The association of cryoanalgesia served to reduce postoperative pain and the need for conventional analgesia. 

References

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