A 48-year-old man with severe pectus excavatum presented with incapacitating supraventricular tachycardia, paroxysmal in nature and invariably provoked by exercise. During mild supine leg exercise on a bicycle ergometer an abnormal increase in right heart pressures, particularly in the right atrium, was observed, followed immediately by supraventricular tachycardia. The latter was also shown during upright exercise on a treadmill. Operative correction of the deformity led to complete relief from the dysrhythmia and a normal haemodynamic response on exercise. The pre- and post-operative studies lend support to the conclusion that the sternal depression was the most likely cause of the cardiac abnormality.
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