Objective: We aimed to arouse awareness of the medical staff and surgeons of possible complications, especially lethal and rare complications, of pectus excavatum (PE) surgery. Summary background data: PE is the most common deformity of the chest wall, characterized by a sternal depression. Patients with PE typically present with cosmetic concerns due to their abnormal appearance, but some patients also report exercise intolerance and shortness of breath. The prevalence and type of life-threatening complications related to the surgical repair of PE are unknown and underreported. We presented a case of lethal cardiac event following the PE surgery. We also systematically reviewed the published case reports. Methods: We described a case of lethal complication of ventricular-fibrillation and cardiac arrest following Ravitch procedure for correction of PE in a 10-year-old boy. We also systematically reviewed relevant cases of PE surgery complications. Results: From the 506 initial records that was retrieved from databases search, 95 case reports form 88 articles were identified over the 23 years. Among them, 79 patients were male, and 17 cases were female. The average age of patients was 18.9 ± 7.7 years (range: 5-53). Complications had occurred up to 37 years from the time of surgery, with most of the cases (23%) occurred during the operation. The most common complications experienced were cardiothoracic complications and displacement of the implanted steel bar. Complications resulted in death in eight cases. Conclusion: We recommend that surgeons should be aware of rare and lethal complications of PE surgery, particularly for cosmetic indications.