PMC4631744_01
A - Preoperative X-ray: deformation of thorax with scoliosis, agenesis of ribs and sternum and displacement of diaphragm attachment upper to inferior thoracic aperture. B - Intraoperative epicardial echocardiography: provider coming to the left atrium through atrial septal defect (ASD II), via atrium free wall puncture. Right minithoracotomy. C - Control echocardiography (TTE) after hybrid procedure - proper implant position, tight atrial septal defect closure. D - Postoperative X-ray - implant and axial skeleton defects. Improvement of aeration of the right lung
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The patient, with hemodynamically significant ASD II, had scoliosis of the thoracic spine with multiple axial skeleton defects, including congenital defects of thoracic vertebrae, defects of the right ribs and agenesis of the sternum (Figure 1 A). The size of the defect was measured in two dimensions using preoperatively transthoracic echocardiography (TTE) and intraoperatively epicardial echocardiography (Figure 1 B). TTE and chest X-ray the proper position of the implant with complete closure of the shunt was observed (Figures 1 C, D). The decrease of blood pressure in the PA was observed in control echocardiography and successful oral feeding was introduced on the second postoperative day.