Pectus excavatum and heart failure

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      Pectus excavatum through displacement and compression of the heart often causes minor cardiac symptoms to appear in adolescence or young adult life with lesser degrees of exercise intolerance. In occasional patients severe cardiac distress occurs. Reported cases of pectus excavatum show an incidence of detectable cardiac abnormality higher than is generally realized.
      The case is reported of a 28-year-old man with a severe pectus excavatum and a history of 2 attacks of cardiac failure in 8 months. Electrocardiographic studies showed auricular fibrillation and marked delay in precordial transition indicating cardiac rotation. Cardiac displacement and rotation were shown in the angiocardiogram. Cardiac catheterization showed a cardiac output one-half as great as the expected normal and elevations in the right auricular and ventricular pressures. Circulation time was delayed. Respiratory function studies showed figures at the lower end of the normal range. At operation 5 costal cartilages were resected on either side and a transverse osteotomy of the sternum performed permitting it to be elevated into the corrected position.
      A year later the electrocardiogram was normal but for a slight delay in precordial transition, the circulation time was normal, cardiac catheterization showed a doubling of cardiac output to a normal figure and significant fall in the right auricular and ventricular pressures, and respiratory functions were entirely normal. The patient is asymptomatic and has done heavy work the entire year.
      Cardiac catheterization in 2 young girls with pectus excavatum which was largely asymptomatic gave essentially normal results. The father of one had a severe funnel chest and in him cardiac catheterization demonstrated a record strongly suggestive of that seen in constrictive pericarditis. In patients with pectus excavatum who show cardiorespiratory symptoms operation should be undertaken with full expectation of providing relief. However, the operation for this deformity produces its best cosmetic and orthopedic results in the youngest patients and it should be undertaken in infancy or childhood, before the secondary orthopedic deformities are marked or fixed and before cardiorespiratory symptoms have had an opportunity to develop.
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