pectus excavatum from Open Heart Surgery or CPR

My daughter had open heart surgery at 3 weeks old to correct a coarctation of the aorta, an 8mm VSD, 2 ASD's and a PDA. She has complete Shones Complex but her valves have not yet been repaired. She also had pulmonary hypertension for two months following surgery. 1 day post-op when they tried to extubate her, she went into cardiac arrest and they preformed CPR for 2 1/2 hours. She did suffer from 3 strokes and was in status epilepticus with over 60 seizures in 48 hours. She is now 18 months old with no lasting effects from the strokes and is seizure free. However, they are now saying she has pectus excavatum. I have noticed the defect since her surgery but thought it was 'normal', possibly caused from when they closed her sternum or that it looked that way because she is so skinny, but it has gotten worse over the last year. There is no history of the disorder in our families. Is it possible that the prolonged CPR caused this or the sternotomy itself resulted in the disorder? Are there any early intervention techniques that would prevent surgery in the future? There is already a propencity for heart and lung deficiencies and it seems that future Open heart surgery can be further complicated in severe cases of pectus excavatum.

[Marie M Gleason, M.D.]

Pectus excavatum can certainly happen after open heart surgery, depending upon how the breastbone heals.  Although one would think that doing CPR would be a potential factor as well, in my experience it is usually not the case.  Regardless, there is no prophylactic action that can be taken to keep it from increasing over time.  If it gets to a significant level, your doctor might recommend surgical insertion of a Nuss bar to try to push the breastbone back outwards from the inside.  This bar is left in place for a year or two, and then removed. The nice thing about this procedure is that the chest does not have to get opened again.  It sounds like your child has been through alot, but is doing well. Best of luck.