case_images: PMC11766175_01
case_images: Pictures published with the patient's consent. (A) Lateral view, pectus excavatum. (B) Hypertelorism, palpebral ptosis, micrognathia, prominent nasolabial folds, low-set ears, pterygium colli. (C) Low posterior hairline. (D) Lymphedema of the lower extremities.
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case_images: jcm-14-00583-f001
case_images: On clinical examination, he demonstrated normal cognitive function, a height of 1.64 m, and phenotypic hallmarks of Noonan syndrome, including hypertelorism, palpebral ptosis, pterygium colli, low-set ears, a low posterior hairline, micrognathia, prominent nasolabial folds, pectus excavatum, and lymphedema of the lower extremities (Figure 1A-D).
case_images: (A) TEE:severe regurgitation with an eccentric jet directed posterior laterally, exhibiting a Coanda effect. (B) TEE:red arrow: mitral valve prolapsed, with a myxomatous appearance, elongated and flailing due to chordal rupture at the A2-A3 level; green arrow: tricuspid valve.
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case_images: PMC11766175_01_jcm-14-00583-g002.jpg
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case_images: The tricuspid valve exhibited mild regurgitation (Figure 2A,B).
case_images: (A) CT scan demonstrating pectus excavatum with a Haller index of 3.1. (B) CT scan and 3D bone reconstruction: the red arrow denotes a malformation of the upper sternum. (C) Lateral view: the red arrow highlights the fusion of the first and second ribs. The red dot marks the incision site in the fourth intercostal space, the green dot indicates the position of the 3D camera, and the blue dot marks the location of the Chitwood clamp.
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case_images: PMC11766175_01_jcm-14-00583-g003.jpg
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case_images: Thoracic imaging demonstrated pectus excavatum with a correction index (CI) of 24%, Haller index (HI) of 3.1 and fusion of the first two ribs on the right hemithorax (Figure 3A-C).
case_images: (A) TEE:3D imaging, visible annuloplasty ring. (B) TEE:red arrow indicates a mild regurgitation jet at A2 level. (C) Postoperative aspect of the mitral valve. (D) Appearance of the scar 6 months postoperatively.
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case_images: Three-dimensional imaging confirmed accurate positioning, with minimal residual regurgitation at A2, which was deemed clinically insignificant (Figure 4A-D).
case_images: Case timeline. ECG:electrocardiogram; TEE:transesophageal echocardiography.
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case_images: PMC11766175_01_jcm-14-00583-g005.jpg
case_images: jcm-14-00583-f005
case_images: We added a case timeline to facilitate a clearer overview of the patient's perioperative course (Figure 5).