Journal of Pediatric Cardiology and Cardiac Surgery

Fontan candidates with pectus excavatum may experience compression of the cardiovascular structures. Simultaneous cardiac surgery and the Nuss procedure is often hesitated in terms of perioperative management in the presence of a pectus bar. We modified the Nuss procedure by placing the pectus bar anterior to the sternum. A 2-year-old girl with dextrocardia and functional single ventricle had undergone the Glenn procedure at 1 year old. Pre-Fontan imaging revealed the significant depression of sternum, raising concerns about postoperative compression of an extracardiac conduit and the pulmonary veins. Therefore, the modified Nuss procedure was simultaneously performed with the Fontan completion. Postoperative computed tomography scan showed the sternum successfully repaired with no evidence of compression of the essential venous pathways. In conclusion, the modified Nuss procedure is a useful technique which can be applied concomitantly with the Fontan type procedure; this is particularly the case when pectus excavatum is likely to be compressing cardiovascular structures.