Pediatric Endosurgery & Innovative Techniques Volume 6, Number 1, 2002 © Mary Ann Liebert, Inc. Case Report Pectus Carinatum as a Sequela of Minimally Invasive Pectus Excavatum Repair ANDRÉ HEBRA, M.D., PATRICK B. THOMAS, M.D., EDWARD P. TAGGE, M.D., WILLIAM T. ADAMSON, M.D., and H. BIEMANN OTHERSEN, M.D. ABSTRACT Reported complications of minimally invasive repair of pectus excavatum (MIRPE) include bar displacement, pneumothorax, pleural effusion, and, rarely, thoracic outlet syndrome, pericarditis, major blood loss, cardiac dysrhythmias, cardiac injury, sternal erosion, and pseudoaneurysm. A 13-year-old boy with severe pectus excavatum (chest index 3.7) under- went MIRPE resulting in 100% correction of the chest wall abnormality. One year after MIRPE, the patient acquired a very pronounced pectus carinatum. Despite immediate re- moval of the pectus bar, the pectus carinatum was persistent for 2 months. The complica- tion of pectus carinatum 1 year following MIRPE is rare and presents unique management dilemmas. Careful postoperative follow-up after MIRPE is recommended to identify patients at risk for development of a carinatum-like deformity so that bar removal can be performed in a timely fashion to halt or reverse the protrusion process. INTRODUCTION T HE OPERATIVE TREATMENT for repair of pectus excavatum (PE) has evolved significantly over the last 4 years since the introductionof the technique of minimally invasive repair of pectus excavatum (MIRPE), also known as the Nuss technique. 1 The cosmetic results achieved with the MIRPE are considered superior to those of the conventional open operation originally described by Ravitch, 2 and the popularity of MIRPE has grown exponentially among pediatric surgeons despite limited reports of outcomes analysis of this new operation.Common complicationsof MIRPE includebar displacement,pneumothorax,infection,and pleural effusions. Unusual complications include thoracic outlet syndrome, pericarditis, massive blood loss, car- diac dysrhythmias, cardiac injury, sternal erosion, and pseudoaneurysm formation. 3 The purpose of this report is to describe a rare case of acquired pectus carinatum that developed after MIPRE. This is the first report identifying acquired pectus carinatum as a complication of MIRPE. A pre- viously reported review of 251 cases of MIRPE 3 did not find a single case of protrusion deformity fol- lowing this operation. 41 Division of Pediatric Surgery Medical University of South Carolina, Charleston, South Carolina.