Surgical strategies for mitral valve diseases associated with pectus excavatum: a narrative review of approaches and outcomes.

OBJECTIVES

To develop a decision-making framework for the surgical management of coexisting mitral valve (MV) prolapse and pectus excavatum, addressing the challenges posed by anatomical complexity and functional compromise.

METHODS

A narrative review of reported cases involving coexisting MV prolapse and pectus excavatum was conducted. Each case was analysed to evaluate the characteristics, personalized surgical strategies and operational details, with a focus on the associated benefits and risks. Additionally, surgical strategies were classified, and process management approaches were explored to guide treatment planning.

RESULTS

The management of coexisting MV prolapse and pectus excavatum was categorized into three tailored approaches: (i) isolated chest wall reconstruction for cardiac decompression in patients with preserved valvular function; (ii) standalone MV repair or replacement for severe regurgitation with mild-to-moderate skeletal deformity (Haller index <3.5) and (iii) single-stage combined procedures for complex presentations (Haller index ≥3.5). A framework for personalized treatment pathways was proposed, incorporating factors such as deformity severity, surgical history and haemodynamic status to optimize approach selection.

CONCLUSIONS

The integration of innovative surgical techniques and minimally invasive approaches offers the potential for safe and effective outcomes. A personalized, anatomically stratified approach is essential for optimizing treatment strategies in patients with this complex comorbidity.