PMC5339422_01
(a) Gross picture shows a deformity of the anterior thoracic cage consistent with pectus excavatum. (b) 3D reconstructed computed tomography image also reveals external compression of basal-to-mid portion of the right ventricle (yellow arrow heads). LV, left ventricle; RV, right ventricle; RVOT, right ventricular outflow tract.
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At present, physical examination revealed a deformity of the anterior thoracic cage consistent with PE (Figure 1(a)). Echocardiography and cardiac computed tomography demonstrated external compression on the basal-to-mid portion of the right ventricle (RV) and dilation of the right atrium and RV apical site with mild hypokinesia (Figures 1(b) and 3(a)).
(a) Electrocardiogram (ECG) shows an rSR' pattern with ST-segment elevation (red arrows) and T-wave inversion on the right precordial leads, indicating a Brugada-like ECG pattern. (b) Six months after Nuss operation even though ST-segment elevation is not fully recovered on lead V1, it seems to be normalized on lead V2-3. (c) Atrial tachycardia was documented on twenty-four-hour ambulatory Holter monitoring before the operation.
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ECG revealed an rSR' pattern with slight ST-segment elevation and T-wave inversion on the right precordial leads, indicating a Brugada-like ECG pattern (Figure 2(a)). Twenty-four hour ambulatory Holter monitoring revealed several episodes of sustained atrial tachycardia with a maximum duration of 5 minutes (Figure 2(c)). ST-segment morphology seemed to be normalized on lead V2-3 (Figure 2(b)).
(a) Cross-sectional computed tomography image shows external compression (red arrow) on the basal-to-mid portion of the right ventricle (RV) and dilation of the right atrium and RV apical site (Haller index 5.21). (b) A lateral view of the chest X-ray after Nuss operation shows that anterior chest wall is decompressed by two Nuss bars underneath the sternum (red arrows) across the chest. RA, right atrium; RV, right ventricle; LV, left ventricle; ant., anterior.
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Nuss operation was carried out, and postoperative chest X-ray demonstrated effective prevention of sternal compression (Figure 3(b)).