Effects of Pectus Excavatum Repair on Right and Left Ventricular Strain

Chieh Ju Chao, Dawn Jaroszewski, Michael Gotway, Mennat Allah Ewais, Susan Wilansky, Steven Jay Lester, Samuel Unzek, Christopher P. Appleton, Hari P Chaliki, Brantley D. Gaitan, Farouk Mookadam, Tasneem Zehra Naqvi

Research output: Contribution to journalArticle

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Abstract

Background The cardiopulmonary benefits of pectus excavatum repair have been debated. Echocardiographic speckle-tracking strain and strain rate have been used to evaluate and detect subclinical myocardial dysfunction in patients receiving cardiotoxic chemotherapy, and patients with valvular heart disease. This technology was applied to evaluate the effects of pectus excavatum surgery on left ventricular (LV) and right ventricular (RV) function. Methods Speckle tracing strain evaluation was performed on intraoperative transesophageal echocardiographic images acquired immediately before and after Nuss repair in adult patients (aged 18 years or more) from 2011 to 2014. Standard severity and compression indices were measured on chest imaging performed before pectus excavatum repair. Results In total, 165 patients with transesophageal echocardiographic images during repair were reviewed (71.5% male; mean age 33.0 years; range, 18 to 71; Haller index 5.7; range, 2.3 to 24.3). Significant improvement after repair was seen in global RV longitudinal strain (−13.5% ± 4.1% to −16.7% ± 4.4%, p < 0.0001) and strain rate (−1.3 ± 0.4 s−1 to −1.4 ± 0.4 s-1, p = 0.0102); LV global circumferential strain (−18.7% ± 5.7% to −23.5% ± 5.8%, p < 0.0001) and strain rate (−1.5 ± 0.5 s-1 to −1.9 ± 0.8 s-1, p = 0.0003); and LV radial strain (24.1% ± 13.5% to 31.1% ± 16.4%, p = 0.0050). There was a strong correlation between preoperative right atrial compression on transesophageal echocardiogram and improvement in RV global longitudinal strain rate immediately after pectus repair. Conclusions Mechanical compression and impaired RV and LV strain is improved by Nuss surgical repair of pectus deformity.

Original languageEnglish (US)
Pages (from-to)294-301
Number of pages8
JournalAnnals of Thoracic Surgery
Volume105
Issue number1
DOIs
StatePublished - Jan 1 2018

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Funnel Chest
Right Ventricular Function
Heart Valve Diseases
Thorax
Technology
Drug Therapy

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Effects of Pectus Excavatum Repair on Right and Left Ventricular Strain. / Chao, Chieh Ju; Jaroszewski, Dawn; Gotway, Michael; Ewais, Mennat Allah; Wilansky, Susan; Lester, Steven Jay; Unzek, Samuel; Appleton, Christopher P.; Chaliki, Hari P; Gaitan, Brantley D.; Mookadam, Farouk; Naqvi, Tasneem Zehra.

In: Annals of Thoracic Surgery, Vol. 105, No. 1, 01.01.2018, p. 294-301.

Research output: Contribution to journalArticle

Chao, CJ, Jaroszewski, D, Gotway, M, Ewais, MA, Wilansky, S, Lester, SJ, Unzek, S, Appleton, CP, Chaliki, HP, Gaitan, BD, Mookadam, F & Naqvi, TZ 2018, 'Effects of Pectus Excavatum Repair on Right and Left Ventricular Strain' Annals of Thoracic Surgery, vol. 105, no. 1, pp. 294-301. https://doi.org/10.1016/j.athoracsur.2017.08.017
Chao, Chieh Ju ; Jaroszewski, Dawn ; Gotway, Michael ; Ewais, Mennat Allah ; Wilansky, Susan ; Lester, Steven Jay ; Unzek, Samuel ; Appleton, Christopher P. ; Chaliki, Hari P ; Gaitan, Brantley D. ; Mookadam, Farouk ; Naqvi, Tasneem Zehra. / Effects of Pectus Excavatum Repair on Right and Left Ventricular Strain. In: Annals of Thoracic Surgery. 2018 ; Vol. 105, No. 1. pp. 294-301.
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abstract = "Background The cardiopulmonary benefits of pectus excavatum repair have been debated. Echocardiographic speckle-tracking strain and strain rate have been used to evaluate and detect subclinical myocardial dysfunction in patients receiving cardiotoxic chemotherapy, and patients with valvular heart disease. This technology was applied to evaluate the effects of pectus excavatum surgery on left ventricular (LV) and right ventricular (RV) function. Methods Speckle tracing strain evaluation was performed on intraoperative transesophageal echocardiographic images acquired immediately before and after Nuss repair in adult patients (aged 18 years or more) from 2011 to 2014. Standard severity and compression indices were measured on chest imaging performed before pectus excavatum repair. Results In total, 165 patients with transesophageal echocardiographic images during repair were reviewed (71.5{\%} male; mean age 33.0 years; range, 18 to 71; Haller index 5.7; range, 2.3 to 24.3). Significant improvement after repair was seen in global RV longitudinal strain (−13.5{\%} ± 4.1{\%} to −16.7{\%} ± 4.4{\%}, p < 0.0001) and strain rate (−1.3 ± 0.4 s−1 to −1.4 ± 0.4 s-1, p = 0.0102); LV global circumferential strain (−18.7{\%} ± 5.7{\%} to −23.5{\%} ± 5.8{\%}, p < 0.0001) and strain rate (−1.5 ± 0.5 s-1 to −1.9 ± 0.8 s-1, p = 0.0003); and LV radial strain (24.1{\%} ± 13.5{\%} to 31.1{\%} ± 16.4{\%}, p = 0.0050). There was a strong correlation between preoperative right atrial compression on transesophageal echocardiogram and improvement in RV global longitudinal strain rate immediately after pectus repair. Conclusions Mechanical compression and impaired RV and LV strain is improved by Nuss surgical repair of pectus deformity.",
author = "Chao, {Chieh Ju} and Dawn Jaroszewski and Michael Gotway and Ewais, {Mennat Allah} and Susan Wilansky and Lester, {Steven Jay} and Samuel Unzek and Appleton, {Christopher P.} and Chaliki, {Hari P} and Gaitan, {Brantley D.} and Farouk Mookadam and Naqvi, {Tasneem Zehra}",
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AU - Chao, Chieh Ju

AU - Jaroszewski, Dawn

AU - Gotway, Michael

AU - Ewais, Mennat Allah

AU - Wilansky, Susan

AU - Lester, Steven Jay

AU - Unzek, Samuel

AU - Appleton, Christopher P.

AU - Chaliki, Hari P

AU - Gaitan, Brantley D.

AU - Mookadam, Farouk

AU - Naqvi, Tasneem Zehra

PY - 2018/1/1

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N2 - Background The cardiopulmonary benefits of pectus excavatum repair have been debated. Echocardiographic speckle-tracking strain and strain rate have been used to evaluate and detect subclinical myocardial dysfunction in patients receiving cardiotoxic chemotherapy, and patients with valvular heart disease. This technology was applied to evaluate the effects of pectus excavatum surgery on left ventricular (LV) and right ventricular (RV) function. Methods Speckle tracing strain evaluation was performed on intraoperative transesophageal echocardiographic images acquired immediately before and after Nuss repair in adult patients (aged 18 years or more) from 2011 to 2014. Standard severity and compression indices were measured on chest imaging performed before pectus excavatum repair. Results In total, 165 patients with transesophageal echocardiographic images during repair were reviewed (71.5% male; mean age 33.0 years; range, 18 to 71; Haller index 5.7; range, 2.3 to 24.3). Significant improvement after repair was seen in global RV longitudinal strain (−13.5% ± 4.1% to −16.7% ± 4.4%, p < 0.0001) and strain rate (−1.3 ± 0.4 s−1 to −1.4 ± 0.4 s-1, p = 0.0102); LV global circumferential strain (−18.7% ± 5.7% to −23.5% ± 5.8%, p < 0.0001) and strain rate (−1.5 ± 0.5 s-1 to −1.9 ± 0.8 s-1, p = 0.0003); and LV radial strain (24.1% ± 13.5% to 31.1% ± 16.4%, p = 0.0050). There was a strong correlation between preoperative right atrial compression on transesophageal echocardiogram and improvement in RV global longitudinal strain rate immediately after pectus repair. Conclusions Mechanical compression and impaired RV and LV strain is improved by Nuss surgical repair of pectus deformity.

AB - Background The cardiopulmonary benefits of pectus excavatum repair have been debated. Echocardiographic speckle-tracking strain and strain rate have been used to evaluate and detect subclinical myocardial dysfunction in patients receiving cardiotoxic chemotherapy, and patients with valvular heart disease. This technology was applied to evaluate the effects of pectus excavatum surgery on left ventricular (LV) and right ventricular (RV) function. Methods Speckle tracing strain evaluation was performed on intraoperative transesophageal echocardiographic images acquired immediately before and after Nuss repair in adult patients (aged 18 years or more) from 2011 to 2014. Standard severity and compression indices were measured on chest imaging performed before pectus excavatum repair. Results In total, 165 patients with transesophageal echocardiographic images during repair were reviewed (71.5% male; mean age 33.0 years; range, 18 to 71; Haller index 5.7; range, 2.3 to 24.3). Significant improvement after repair was seen in global RV longitudinal strain (−13.5% ± 4.1% to −16.7% ± 4.4%, p < 0.0001) and strain rate (−1.3 ± 0.4 s−1 to −1.4 ± 0.4 s-1, p = 0.0102); LV global circumferential strain (−18.7% ± 5.7% to −23.5% ± 5.8%, p < 0.0001) and strain rate (−1.5 ± 0.5 s-1 to −1.9 ± 0.8 s-1, p = 0.0003); and LV radial strain (24.1% ± 13.5% to 31.1% ± 16.4%, p = 0.0050). There was a strong correlation between preoperative right atrial compression on transesophageal echocardiogram and improvement in RV global longitudinal strain rate immediately after pectus repair. Conclusions Mechanical compression and impaired RV and LV strain is improved by Nuss surgical repair of pectus deformity.

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