case_images: PMC5339422_01
case_images: (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.
case_images: CRIC2017-3047937.001.jpg
case_images: PMC5339422_01_CRIC2017-3047937.001.jpg
case_images: fig1
case_images: 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)).
case_images: (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.
case_images: CRIC2017-3047937.002.jpg
case_images: PMC5339422_01_CRIC2017-3047937.002.jpg
case_images: fig2
case_images: 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)).
case_images: (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.
case_images: CRIC2017-3047937.003.jpg
case_images: PMC5339422_01_CRIC2017-3047937.003.jpg
case_images: fig3
case_images: Nuss operation was carried out, and postoperative chest X-ray demonstrated effective prevention of sternal compression (Figure 3(b)).