Union Hospital, Tongji Medical College, HUST: One-Stage Repair of Complete Sternal Cleft with Severe Pectus Excavatum in a 12-Year-Old
🔎 Recently, the pediatric surgery team led by Professor Shuai Li at Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, performed surgery on a 12-year-old boy. A midline chest wall depression was noticed soon after birth and gradually worsened with age. He developed chest tightness and shortness of breath on exertion, and avoided sports because of the visible deformity. Examination revealed a longitudinal midline depression of about 2 × 8 cm over the sternum, with cardiac pulsation visible through the defect and paradoxical movement of the chest wall during breathing.
📋 Chest CT showed sternal dysplasia with failure of normal fusion, an arch-shaped inward deformity compressing the right atrium and right ventricle, and a shortened anteroposterior chest diameter. The Haller index was 3.5. Pulmonary function testing indicated mild obstructive ventilatory impairment. The final diagnosis was congenital complete sternal cleft with severe pectus excavatum.
⚠️ This case presented two main challenges:
• The sternum had to be repaired and the anterior chest wall reconstructed, while the inward-depressed chest wall was corrected at the same time.
• The depressed sternum lay directly against the heart and great vessels, so any misstep during dissection could cause serious injury.
🛠️ Surgical strategy and key steps:
1. Thoracoscopic assistance: under direct thoracoscopic vision, the tissue in the retrosternal space adjacent to the heart and great vessels was carefully dissected to create a safe passage for bar placement. This was the highest-risk step of the entire procedure;
2. Bar correction: two corrective bars were inserted to lift the depressed chest wall forward and secure it, relieving compression on the right atrium and right ventricle;
3. Cartilage bridge osteotomy: traction and tension in the costal cartilage were released so that the chest wall could hold a stable shape after correction;
4. Sternal reconstruction: the divided sternum was reconstructed in the same operation, restoring the anterior chest wall's protection of the heart and great vessels.
The operation took about 5 hours, with approximately 15 mL of blood loss. Correction and reconstruction were completed in a single stage.
📊 The patient was transferred directly to the general ward after surgery. Postoperative CT showed that the costal cartilage depression was corrected and cardiac compression was relieved. He was discharged on postoperative day 11. Follow-up will include regular assessment of chest wall shape, respiratory function, sternal and costal cartilage healing, bar position, and chest wall stability.
💡 Our takeaway: whether a chest wall deformity needs surgery cannot be judged by appearance alone. It requires a comprehensive assessment of chest wall structure, progression of the deformity, symptoms, and cardiopulmonary function. For rare, complex deformities like this one, precise preoperative imaging and safe thoracoscopic dissection are key.