About Pectus Excavatum

  It is a congenital chest deformity characterized by a curved depression of the sternum and ribs.

  There are no ECG findings specific to pectus excavatum.

      Still, patients with pectus excavatum may show some abnormal ECG findings.




Frequently observed ECG findings in Pectus Excavatum

  Incomplete right bundle branch block (
most common).

  Complete right bundle branch block.

  Right axis deviation.

  rSr' pattern in lead V1. The r' is usually small.

  Increased P wave amplitude in lead II.

  A negative P wave in lead V1, similar to that of lead aVR.




About Nuss procedure

  This is a surgical technique of minimally invasive repair of pectus excavatum using pectus bar.

  A curved bar (usually stainless steel)is inserted to the patient’s chest to correct the sternal deformity.

  The bars get removed after an average of 3 years.




Effects of corrective surgery (Nuss procedure) on ECG

  J waves
may appear in leads V4, V5, and V6 (elevated J points)

     
J waves disappear after removal of the pectus bar.

 
Chest leads may show a decrease in QRS amplitude.

      QRS amplitude may increase again after removal of the pectus bar.

  The rSr' pattern in preoperative ECGs may disappear after the operation.

  Preoperatively increased P wave amplitude in lead II may decrease after the operation.




References (including links to free full-text articles)

  J Electrocardiol 2016;49(2):174-181.

  Ann Cardiothorac Surg 2016;5(5):422-433.

  Anadolu Kardiyol Derg 2011;11(1):77-78.

  Thorac Surg Clin 2010;20(4):583-597.





ECG 1. The ECG above belongs to a 23 years-old man with pectus excavatum (funnel chest).
ECHOcardiography was normal (no structural heart disease).
Incomplete right bundle branch block is seen.

Click here for a more detailed ECG





ECG 2a. The ECG tracing above belongs to a 21 years-old patient with pectus excavatum (funnel chest).
The patient is waiting for corrective surgery.
This patient has right bundle branch block.

Dr. Beata Podlejska has donated the above ECG to our website.




ECG 2b. The ECG tracing above belongs to a 21 years-old patient with pectus excavatum (funnel chest).
The patient is waiting for corrective surgery.
This patient has right bundle branch block.

Click here for a more detailed ECG

Dr. Beata Podlejska has donated the above ECG to our website.




ECG 2c. The ECG tracing above belongs to a 21 years-old patient with pectus excavatum (funnel chest).
The patient is waiting for corrective surgery.
This patient has right bundle branch block.

Click here for a more detailed ECG

Dr. Beata Podlejska has donated the above ECG to our website.




ECG 2d. The ECG tracing above belongs to a 21 years-old patient with pectus excavatum (funnel chest).
The patient is waiting for corrective surgery.
This patient has right bundle branch block.

Click here for a more detailed ECG

Dr. Beata Podlejska has donated the above ECG to our website.