Left parasternal approach for Bentall procedure in a patient of Marfan syndrome with severe pectus excavatum

  • Pankaj Aggarwal
  • Sachin Mahajan
  • Siddharth Garg
Case report


Annuloaortic ectasia with ascending aortic aneurysm with severe aortic regurgitation with severe left ventricular dysfunction is a serious condition especially in patients with Marfan syndrome (MFS) simultaneously having severe pectus excavatum (PE) deformity. We report our left parasternal approach in such patient in whom median sternotomy was not feasible. We achieved excellent exposure of dislocated heart and great vessels enabling Bentall procedure. Since patient did not consent for combined correction of chest wall deformity, we plan to undertake it later. Therefore, we conclude that left parasternal approach is feasible for standard aortic root replacement surgery in severe PE.


Left parasternal approach Annuloaortic ectasia Bentall procedure 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from patient included in the study.


  1. 1.
    Geva T, Hegesh J, Frand M. The clinical course and echocardiographic features of Marfan’s syndrome in childhood. Am J Dis Child. 1987;141:1179–82.PubMedGoogle Scholar
  2. 2.
    Scherer LR, Arn PH, Dressel DA, Pyeritz RM, Haller JA Jr. Surgical management of children and young adults with Marfan syndrome and pectus excavatum. J Pediatr Surg. 1988;23:1169–72.CrossRefPubMedGoogle Scholar
  3. 3.
    Willekes LC, Backer LC, Mavroudis C. A 26-year review of pectus deformity repairs, including simultaneous intracardiac repair. Ann Thorac Surgery. 1999;67:511–8.CrossRefGoogle Scholar
  4. 4.
    Tomomi H, Masaihiho Y, Yoshihiro O, Naoki Y, Shigeteru O, Yoshio O. Simultaneous repair of pectus excavatum and congenital heart disease over the past 30 years. Eur J Cardiothorac Surg. 2002;22:874–8.CrossRefGoogle Scholar
  5. 5.
    Welch KJ, Castenada AR, Keane JF, Fyler DC, Shamberger RC. Anterior chest wall deformities and congenital heart disease. J Thorac Cardiovasc Surg. 1988;96:427–32.PubMedGoogle Scholar
  6. 6.
    Javangula KC, Batchelor TJ, Jaber O, Watterson KG, Papgiannopoulos K. Combined severe pectus excavatum correction and aortic root replacement in Marfan’s syndrome. Ann Thorac Surg. 2006;81:1913–5.CrossRefPubMedGoogle Scholar
  7. 7.
    Shiraishi M, Yamaguchi A, Tamura A, Naito K, Adachi H. Combined aortic root replacement and pectus excavatum correction in Marfan’s syndrome. Kyobu Geka. 2010;63:1049–52.PubMedGoogle Scholar
  8. 8.
    Sacco Casamassima MG, Wong LL, Papandria D, et al. Modified nuss procedure in concurrent repair of pectus excavatum and open heart surgery. Ann Thorac Surg. 2013;95:1043–9.CrossRefPubMedGoogle Scholar

Copyright information

© Indian Association of Cardiovascular-Thoracic Surgeons 2017

Authors and Affiliations

  • Pankaj Aggarwal
    • 1
  • Sachin Mahajan
    • 1
  • Siddharth Garg
  1. 1.Department of CTVSPGIMERChandigarhIndia

Personalised recommendations