My otherwise healthy 12 year old is having tests run to see if his pectus excavatum needs surgical repair.
We have noticed that his younger brother, a 9 year old Fontan patient, looks to have the same condition.
I know he will need to be a bit older, but is the Nuss procedure performed on Fontan patients?
Knowing his sternum has been broken three times, there would be scar tissue involved.
Pectus excavatum is a finding in which the chest wall can be "sunken in". It can be mild, moderate, or severe. Without evaluating your son, I cannot say exactly what he needs. however, the VAST majority of pectus excavatum is benign an dneeds no intervention. In fact, it is essentially a cosmetic repair. For patients who have had cardiac surgery, they can have defomities of the chest wall due to the fact that their breastbone (sternum) was opened and then sewn back together. Unless there is demonstrated adverse impact on the Fontan circulation by compression of the lungs and/or heart, it is probably not advisable to have this done. Every time surgery is done on the chest wall, scar tissue forms and makes subsequent surgeries progressively more difficult. The ability to access the heart through all the scar tissue becomes both more difficult and more risky. We think that a fair number of patients with Fontan circulation may be at risk for the eventual need for a heart transplant in the future, as well, so the fewer surgeries on his chest, the better. You may want to discuss this further with your cardiologist, though, to understand how much this may (or may not) be impacting on his Fontan physiology.
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