Effects of Pectus Excavatum Repair on Right and Left Ventricular Strain Chieh-Ju Chao, MD, Dawn Jaroszewski, MD, Michael Gotway, MD, MennatAllah Ewais,

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Presentation transcript:

Effects of Pectus Excavatum Repair on Right and Left Ventricular Strain Chieh-Ju Chao, MD, Dawn Jaroszewski, MD, Michael Gotway, MD, MennatAllah Ewais, MD, Susan Wilansky, MD, Steven Lester, MD, Samuel Unzek, MD, Christopher P. Appleton, MD, Hari P. Chaliki, MD, Brantley D. Gaitan, MD, Farouk Mookadam, MB, BCh, Tasneem Z. Naqvi, MD, FRCP The Annals of Thoracic Surgery Volume 105, Issue 1, Pages 294-301 (January 2018) DOI: 10.1016/j.athoracsur.2017.08.017 Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions

Fig 1 The definitions of computed tomography and magnetic resonance imaging (CT/MRI) indices and abbreviations are demonstrated on a computed tomography image. All measurements were performed in both inspiratory and expiratory phases: maximum transverse diameter (A), minimum anteroposterior dimension (B), maximum distance between a line placed on the anterior spine (dotted line), and the inner margin of the most anterior portion of the chest (C) [measured on the side with greater chest anteroposterior dimension, which is right side of chest in this figure]. Haller index = (A) divided by (B); correction index = (C) minus (B) divided by (C) times 100%. The Annals of Thoracic Surgery 2018 105, 294-301DOI: (10.1016/j.athoracsur.2017.08.017) Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions

Fig 2 Transesophageal echocardiographic images demonstrating the effect of pectus repair surgery on right-side heart chamber size. (A) Mid esophageal, four-chamber view demonstrating compression of right atrium (RA), tricuspid valve annulus, and basal portion of right ventricle (RV) in end systole before Nuss pectus excavatum (PE) surgical repair. Prolapsing tricuspid valve (TV) is shown by yellow arrow. (B) Relief of RA, tricuspid annulus, and basal RV compression immediately after Nuss PE repair. Note the normal appearance of tricuspid valve (yellow arrow). (C) Mid esophageal views in end diastole demonstrating a narrow RV outflow tract (RVOT [yellow arrow labeled A, before surgery]), which (D) increased (yellow arrow labeled A) after surgery. Mechanical compression of the sternum on the RVOT is also demonstrated in (C), and as relieved by surgical repair (D). (LA = left atrium; LV = left ventricle; LVOT = left ventricular outflow tract.) The Annals of Thoracic Surgery 2018 105, 294-301DOI: (10.1016/j.athoracsur.2017.08.017) Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions

Fig 3 Linear correlations of computed tomography (CT) and magnetic resonance imaging (MRI) cardiac compression indices and right heart chamber size/strain measurements. There was a strong correlation between (A) expiratory CT/MRI minimum (min) chest anterior-posterior (AP) diameter and preoperative (pre-op) right atrium (RA) size; (B) minimum chest AP diameter and improvement in RA size after surgery; and (C) correction index (COI) AP with the improvement of right ventricle global longitudinal strain rate (RVGLSR). The Annals of Thoracic Surgery 2018 105, 294-301DOI: (10.1016/j.athoracsur.2017.08.017) Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions

Fig 4 Preoperative (A) right atrium (RA) size and (B) right ventricle global longitudinal strain rate (RVGLSR) correlated with an improvement in RVGLSR after pectus excavatum repair surgery. Note that right ventricle strain and strain rate are negative values, and more negative values of strain and strain rate indicate better contractile function. That also gives a negative correlation coefficient and indicates the more impairment of strain rate at baseline gives a greater improvement of strain function. (pre-op = preoperative.) The Annals of Thoracic Surgery 2018 105, 294-301DOI: (10.1016/j.athoracsur.2017.08.017) Copyright © 2018 The Society of Thoracic Surgeons Terms and Conditions