Subscribe to RSS
DOI: 10.1055/s-0039-1692195
Devastating Complications of Metal Strut Migration Following Pectus Excavatum Repair
Publication History
01 November 2018
28 April 2019
Publication Date:
12 July 2019 (online)
Abstract
The modified Ravitch technique with metal struts and the Nuss operation have been the dominant operative techniques for treatment of pectus excavatum in the previous decades. We present devastating postoperative complications of a 16-year-old boy after the modified Ravitch procedure for a severe deformity utilizing two metal bars. Four months following surgery, one strut was removed after the displacement noted on a regular postoperative examination. Ten days after the strut removal, the patient complained of lower limb pain but the sensations were attributed to physical inactivity. Two months later, after pain intensification, the boy was diagnosed with bilateral arterial and venous lower limb thromboses and subsequently, the migration of the remaining metal strut intracardially with the free end in the left ventricular cavity embedded in massive thrombi. An urgent cardiac procedure was performed and the bar removed. Postoperatively, the boy made a full cardiac recovery but with severe neurological complications and subsequent death. Migration of metal struts is a rare complication and, except in our case, had been dealt with successfully. This case should emphasize more attention to the postoperative follow-up management of such patients.
-
References
- 1 Nuss D, Kelly RE. Congenital chest wall deformities. In: Holcomb GW, Murphy JP, Ostlie DJ. , eds. Ashcraft's Pediatric Surgery. 6th ed. Philadelphia, PA: Elsevier Saunders; 2014
- 2 Elami A, Lieberman Y. Hemopericardium: a late complication after repair of pectus excavatum. J Cardiovasc Surg (Torino) 1991; 32 (04) 539-540
- 3 Dalrymple-Hay MJ, Calver A, Lea RE, Monro JL. Migration of pectus excavatum correction bar into the left ventricle. Eur J Cardiothorac Surg 1997; 12 (03) 507-509
- 4 Stefani A, Morandi U, Lodi R. Migration of pectus excavatum correction metal support into the abdomen. Eur J Cardiothorac Surg 1998; 14 (04) 434-436
- 5 Onursal E, Toker A, Bostanci K, Alpagut U, Tireli E. A complication of pectus excavatum operation: endomyocardial steel strut. Ann Thorac Surg 1999; 68 (03) 1082-1083
- 6 Tahmassebi R, Ashrafian H, Salih C, Deshpande RP, Athanasiou T, Dussek JE. Intra-abdominal pectus bar migration--a rare clinical entity: case report. J Cardiothorac Surg 2008; 3: 39
- 7 Morimoto K, Imai K, Yamada A, Fujimoto T, Matsumoto H, Niizuma K. Migration of a pectus bar into the ribs. J Plast Reconstr Aesthet Surg 2008; 61 (02) 225-227
- 8 Zhang R, Hagl C, Bobylev D. , et al. Intrapericardial migration of dislodged sternal struts as late complication of open pectus excavatum repairs. J Cardiothorac Surg 2011; 6: 40