0477: Compression of the right ventricle by pectus excavatum in a gymnast: a case report

IntroductionThe pectus excavatum is the most common chest deformation. It is usually congenital or develops during growth. In addition to aesthetic problems, it can cause cardiac compression, breathing difficulties and constant pain. This affection may limit the practice of sports especially when a sporting career is considered.Clinical case presentationWe report the case of gymnast girl in the national team who’s 15 years old. She complains since several months dyspnea and faintness on exertion. The physical examination revealed a mild pectus excavatum. The resting electrocardiogram showed an incomplete right bundle branch block. A 24 hour holter monitoring showed one episode of a nocturnal non sustained ventricular tachycardia composed of 12 beats with a left bundle branch morphology. Transthoracic echocardiography was normal. A stress test was conducted revealing the occurrence of a single ventricular extrasystole and dizziness at the end of the test. Cardiac MRI was realized showing a significant compression of the right ventricle by the pectus excavatum with no signs of arrhythmogenic right ventricular dysplasia. The pulmonary function was normal. Despite the mild clinical form of this pectus excavatum the cardiac impact seems significant. Temporary sports inaptitude was indicated for further explorations and therapeutic decisions. Remodeling surgery is being discussed for herConclusionIs surgery mandatory for this patient if she gives up sports? The treatment of this deformation may it allow this gymnast to continue her high level training? This case was rarely reported and underlines the importance of a working group in order to make a decision regarding this kind of pathology