Incremental value of three-dimensional transthoracic echocardiography over the two-dimensional modality in the assessment of right heart compression and dysfunction produced by pectus excavatum

VALUE OF ECHOCARDIOGRAPHIC DIASTOLIC FUNCTION REACTIVITY UNDER EXERCISE LOAD

ABSTRACT Introduction: Left ventricular diastolic dysfunction is one of the important long-term survival and prognosis factors in patients with coronary heart disease. Objective: To evaluate the diastolic function of the left ventricle in patients with coronary heart disease (CHD) using 3D speckle tracking echocardiography (3D-STE). Methods: Full volume images of four apical cavities were collected, and 4D Auto LVQ software was used for offline analysis to obtain longitudinal strain (GLS), circumferential strain (GCS), area strain (GAS) and radial strain (GRS) of the left ventricle as a whole (four three-dimensional strain indicators). Results: The receiver operating characteristic (ROC) curve analysis showed that the sensitivity and specificity of GLS in predicting left ventricular diastolic dysfunction were both 68% at −15.5%. The sensitivity and specificity of GCS for predicting left ventricular diastolic dysfunction at −17.5% were 76% and 81%, and those of GAS at −29.5% were 84% and 68%, respectively. Conclusions: The strain parameters of 3D-STE can be used to predict LVEDP in patients with coronary heart disease with normal left ventricular ejection fraction, and can be used as a new ultrasonic diagnostic index to evaluate left ventricular diastolic function in patients. Level of evidence II; Therapeutic studies - investigation of treatment results.

Evolution of Technique and Results Following Permanent Open Repair for Pectus Deformities

Objective

Open correction of pectus deformities has evolved since its origin. We performed a Ravitch type repair using a permanent titanium plate fixed with screws and describe the procedure with outcomes after our modifications.

Methods

A retrospective review of 61 pectus excavatum and pectus carinatum cases from August 2013 to April 2021 was performed. Data were extracted from medical records and reported. In January 2016, we began administering satisfaction surveys at the 6-month postoperative visit; results are reported.

Results

The mean age of our cohort was 24.5 years; 43 (70%) were male. Fifty-four underwent pectus excavatum repair, 6 pectus carinatum repair, and 1 mixed repair. Median Haller index was 3.8. Mean operative duration was 98 minutes; mean blood loss was 116.4 mL. Median chest tube duration was 5.0 days; median hospital stay was 4 days. Reexploration for bleeding was 30% in the first 10 patients. Protocol changes including postponing chemical deep vein thrombosis prophylaxis, using intraoperative hemostatic agents, and using shorter implantation screws decreased this to 0% for the remaining cases. The most frequent complication was urinary retention (21.3%). Postoperative surveys were completed for 37 of 50 patients. Seventy-five percent reported health improved, 65% reported exercise capacity improved, 75% reported breathing improved, and 59% reported chest pain improved. Self-esteem improved from 6.6 ± 2.5 (of 10) before surgery to 8.2 ± 2.1 after surgery. Ninety percent were satisfied and 86% would have the operation again.

Conclusions

Ravitch type repair with permanent titanium plate fixation is a safe and effective procedure for correction of pectus excavatum and carinatum. Most patients experience improvement in preoperative symptoms.

Usefulness of right ventricular strain assessment in submassive pulmonary thromboembolism undergoing ultrasound-facilitated thrombolysis

Massive and submassive pulmonary thromboembolism carry significant morbidity and mortality. We present an elderly female who was diagnosed with a submassive pulmonary embolism by computed tomographic angiography and treated with ultrasound-facilitated thrombolysis (UFT). This case demonstrates the usefulness of right ventricular longitudinal strain measurements by two-dimensional speckle tracking echocardiography in the evaluation of right ventricular function before and after UFT. Evaluation of right ventricle longitudinal strain by speckle tracking echocardiography may supplement other parameters in the assessment of right ventricular function in these patients.