Two cases of pectus-related heart problems, initially considered just 'cosmetic' by cardiologists

People with pectus excavatum and specialists that care for people with pectus are well-aware of the physical manifestations of pectus. However, many general practitioners and other physicians still believe that pectus is always cosmetic. This is simply not true.

Two examples of pectus affecting the heart are clearly described in a newly published report in The Annals of Thoracic Surgery by Dr. Dawn Jaroszewski and colleagues from Phoenix.

Patient #1: The first patient developed pectus excavatum in adolescence. She had symptoms including shortness of breath and exercise intolerance but did not receive treatment. She eventually needed a heart transplant for a separate condition called hypertrophic cardiomyopathy. The cardiac compression occurring from her pectus led to severe blood pressure dysfunction and surgical repair of pectus was necessary.

Patient #2: The second patient experienced cardiac electrical conduction problems due to a different type of cardiomyopathy. However, this patient had a failing heart valve and a shifted heart in the left part of her chest due to her pectus deformity. She underwent a heart transplant but the pectus deformity was compressing the heart graft, leading to unstable vital signs. As a result, similar to the first case, this patient then required pectus repair.

Remarkably, in both cases, the patients were previously told by multiple cardiologists that their pectus condition was merely a cosmetic concern.

These cases contribute to a growing literature describing how pectus can affect the heart and lungs. We now know that pectus repair can lead to improvements in cardiac strain and cardiac output.

These patients had other underlying heart problems and needed heart transplants, but it was determined that pectus repair was required to achieve stability of the sternum after closing the chest. These unique cases demonstrated the effect of pectus on the heart in the acute setting.

More carefully-controlled studies will be needed to understand the isolated influence of pectus superimposed with other heart conditions.

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