Pectus excavatum is the most common chest wall deformity. Severe pectus excavatum can significantly impact both the physiological and psychological health of patients, necessitating timely therapeutic intervention. The Nuss procedure is currently the preferred surgical approach for treating moderate to severe pectus excavatum. However, in cases of severe pectus excavatum, the placement of the corrective steel bar through the anterior mediastinum poses a substantial risk of injury to the heart, major blood vessels, and lung tissue. This article reports a case of a 17-year-old patient with severe pectus excavatum combined with Marfan syndrome. CT examination revealed a Haller index of 14.07, with severe sternal depression leading to significant narrowing of the anterior mediastinal space and complete displacement of the heart into the left thoracic cavity, resulting in an extremely high surgical risk. We employed a simplified sternal elevation technique in conjunction with the Nuss procedure for treatment. During the operation, a sternal retractor was used to elevate the sternum, thereby enlarging the retrosternal space and facilitating the successful completion of the Nuss procedure. This approach effectively avoided damage to the heart and major blood vessels, resulted in no surgical complications, and achieved a satisfactory corrective outcome.
Pectus excavatum is the most common chest wall deformity, and the Nuss procedure has become the most widely used surgical treatment owing to its minimally invasive nature and reliable corrective outcomes. However, during the critical step in which the introducer and corrective bar traverse the anterior mediastinum, rare but potentially fatal complications may occur, including injury to the lungs, heart, and great vessels. Although thoracoscopic assistance can reduce the incidence of these events to some extent, it cannot eliminate the risk entirely. To further enhance intraoperative safety, various sternal elevation techniques (SET) have been introduced in recent years and applied in combination with the Nuss procedure for the treatment of pectus excavatum. By temporarily elevating the sternum and anterior chest wall to enlarge the retrosternal space, SET may facilitate safer mediastinal passage and mitigate the risk of cardiopulmonary and major vascular injury. This review summarizes the technical characteristics and recent clinical advances of different SET modalities used in conjunction with the Nuss procedure, analyzes their advantages and limitations, and provides a reference for future research and clinical practice.
