IJTCVS Bayram et al 173 2005; 21: 173–174 Pectus and ASD Address for correspondence: Dr. Ahmet Sami Bayram Thoracic Surgery Department of Medical Faculty of Uludag University Gorukle-Bursa/Turkey 16059 Tel : +90 224 4429166 Fax : +90 224 4428698 e-mail : asbayram2@yahoo.com ©IJTCVS097091342120605/56 Introduction Pectus excavatum and pectus carinatum are found with congenital heart disease rarely. Recognition of this association is important for optimal correction of both conditions 1 . We performed simultaneous pectus repair and the closure of atrial septal defect (ASD) in two children. Concomitant repair of congenital heart defects and pectus deformity may be performed successfully without additional morbidity, while avoiding two procedures. Patients Two children were admitted for the simultaneous repair of ASD and pectus deformity. Pectus excavatum and ASD was observed in a five-year old girl and pectus carinatum and ASD in a eight-year old boy. Approximately 6-7 cm mid-sternal skin incision was used for the operation. The pectoralis major muscles were dissected away from the sternum and deformed cartilages. Perichondrium of the right four lowermost deformed cartilages were opened and cartilages were removed. All attachments of the cartilage beds were divided from the sternum. A small finochietto-type sternal retractor was placed to the right of the sternum, displacing the sternum to the left and the costal cartilage bed to the right allowing access to the heart. An appropriate dose of heparin was administered and cardiopulmonary bypass was instituted. The repair of the ASD was accomplished (Fig. 1a and b). Following the termination of cardiopulmonary bypass, protamine was given. The sternum was dissected free from the left Simultaneous Repair of Pectus Deformities and Atrial Septal Defect Ahmet Sami Bayram* MD, Isik Senkaya** MD, Cengiz Gebitekin 1 MD Department of Thoracic Surgery*, Department of Cardiovascular Surgery**, Medical Faculty of Uludag University neurovascular bundles medial to the internal thoracic artery to the level of the third costal cartilages. After that, osteotomy was performed at the level of the 4 th cartilage and fixed with wire suture. Following the correction of the deformity, all intercostals bundles were attached to the sternum using 2/0 Vicryl sutures. The same technique was used in both cases. Picture-2a,b shows the pre and postoperative appearance of the patient with pectus carinatum, picture-2c,d pectus excavatum. The cosmetic appearance remains excellent in both patients at one and two years postoperatively. Received -16/11/03; Review Completed - 04/08/04; Accepted - 01/03/05. Fig. 1a. ASD appearance, b. ASD accomplished Discussion Pectus excavatum and, less commonly, pectus carinatum are chest wall deformities in children. These deformities are rare, with a reported incidence of 0.01-0.1% 2 . Abnormal cardiac findings associated with pectus deformities range from benign functional murmurs to single ventricle physiology. The flow murmurs may be innocent or may possibly be related to compression of the right ventricular outflow tract 3 . A review from the Children‘s Hospital in Boston revealed that the incidence of accompanying congenital heart defects was 0.17% 1 . Willeken et al. 3 ; reported that the most common associated intracardiac pathology was an ASD. Although numerous modifications have been used for the simultaneous repair of heart defect and pectus deformities, there are two main approaches. One 056-03.p65 5/13/2005, 3:31 PM 173