Document Detail

Echocardiographic diagnosis of right ventricular inflow compression associated with pectus excavatum during spinal fusion in prone position.
MedLine Citation:
PMID:  19489950     Owner:  NLM     Status:  MEDLINE    
INTRODUCTION: Pectus excavatum is commonly viewed as a benign condition. Associated alterations in hemodynamics are rare. We present an unusual case of right ventricular inflow obstruction and hemodynamic compromise as a consequence of pectus excavatum encountered during surgical intervention.
CASE: a 15-year-old male with pectus excavatum and thoracolumbar scoliosis developed severe hypotension after induction of general anesthesia and placement in the prone position for elective spinal fusion. A transesophageal echocardiogram revealed anterior compression of the right heart by the sternum with peak and mean right ventricular inflow gradients of 7 and 4 mm Hg, respectively. The gradient resolved with supine positioning and was reproduced with direct compression of the sternum.
CONCLUSIONS: Although pectus excavatum is generally a benign condition, the cardiologist should be aware of the potential for serious hemodynamic compromise related to positioning in these patients.
James M Galas; Mary E van der Velde; S Devi Chiravuri; Frances Farley; David Parra; Gregory J Ensing
Publication Detail:
Type:  Case Reports; Journal Article    
Journal Detail:
Title:  Congenital heart disease     Volume:  4     ISSN:  1747-0803     ISO Abbreviation:  Congenit Heart Dis     Publication Date:    2009 May-Jun
Date Detail:
Created Date:  2009-06-03     Completed Date:  2009-10-02     Revised Date:  2011-05-05    
Medline Journal Info:
Nlm Unique ID:  101256510     Medline TA:  Congenit Heart Dis     Country:  United States    
Other Details:
Languages:  eng     Pagination:  193-5     Citation Subset:  IM    
Pediatrics Cardiology, University of Michigan Health System, MI, USA.
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MeSH Terms
Echocardiography, Doppler, Color*
Echocardiography, Transesophageal*
Funnel Chest / complications,  physiopathology,  surgery*
Hypotension / etiology,  physiopathology,  ultrasonography*
Lumbar Vertebrae
Prone Position*
Scoliosis / complications
Spinal Fusion*
Sternum / ultrasonography
Supine Position*
Thoracic Vertebrae
Treatment Outcome
Ventricular Outflow Obstruction / etiology,  physiopathology,  ultrasonography*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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