PMC6625957_01
(
A
) Preoperative severe pectus excavatum; (
B
) displacement of the inferior metal strut; (
C
) the postoperative position of the remaining strut.
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The superior vena cava (SVC) pathway was clear, but the inferior vena cava (IVC) system was partially occluded with two long plaques below the cavoatrial junction ( Fig. 1 ). 
(
A
) Lower limb angiography showing partial occlusion of both femoral arteries and absent circulation in the popliteal arteries; (
B
) the lateral X-ray of the remaining strut.
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PMC6625957_01_10-1055-s-0039-1692195-i180416cr-2.jpg
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An indication for urgent cardiac operation and strut removal was quoted to the parents with high intraoperative risks ( Fig. 2 ). 
(
A
) Intracardial metal strut ending its course in the left ventricle "muffed" by thrombus; (
B
) iatrogenic ventricular septal defect after strut and thrombus removal.
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After the cardiac arrest, the strut was removed without resistance ( Figs. 3 and 4 ). 
Intraoperative moment of metal strut removal.
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PMC6625957_01_10-1055-s-0039-1692195-i180416cr-4.jpg
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After the cardiac arrest, the strut was removed without resistance ( Figs. 3 and 4 ). 
VSD closed with a PTFE patch with repair of the RV wall. PTFE, polytetrafluoroethylene; RV, right ventricular; VSD, ventricular septal defect.
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PMC6625957_01_10-1055-s-0039-1692195-i180416cr-5.jpg
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The VSD was closed with a 0.6 mm polytetrafluoroethylene (PTFE) patch and the cardiac apex reconstructed with direct pledgeted sutures ( Fig. 5 ). 