Repair of Pectus Excavatum at the Time of Reoperative Cardiac Surgery.

Severe pectus excavatum at the time of redo cardiac surgery presents unique challenges for sternal reentry and reconstruction. We present the case of a 14-year-old boy with tetralogy of Fallot, prior transannular patch repair, and severe pectus excavatum who presented for pulmonary valve replacement and pectus repair. A modified Ravitch procedure with subperichondrial resection of the costal cartilages allowed for sternal mobilization, safe reentry, and excellent reconstruction. This is a safe and reproducible technique for dealing with the challenging scenario of severe pectus excavatum in patients undergoing redo cardiac surgery.