Southwestern Surgical Congress Surgical repair of pectus excavatum relieves right heart chamber compression and improves cardiac output in adult patientsdan intraoperative transesophageal echocardiographic study Chieh-Ju Chao, M.D. a , Dawn E. Jaroszewski, M.D. b , Preetham N. Kumar, M.D. a , MennatAllah M. Ewais, M.D. b , Christopher P. Appleton, M.D. a , Farouk Mookadam, M.B., B.Ch. a , Michael B. Gotway, M.D. c , Tasneem Z. Naqvi, M.D., M.M.M. a, * a Echocardiography Laboratory, Division of Cardiology, Mayo Clinic, CK 27, 13400 E Shea Boulevard, Scottsdale, AZ, 85259, USA; Divisions of b Cardiothoracic Surgery and c Radiology, Mayo Clinic, Scottsdale, AZ, USA KEYWORDS: Pectus excavatum; Nuss surgery; Right heart; Cardiac output; Transesophageal echocardiography; Doppler ultrasound Abstract BACKGROUND: Cardiac compression in pectus excavatum (PE) deformity and effect of PE surgery on cardiac function in adults have been debated. We examined the effect of PE correction on right heart size and cardiac output. METHODS: A retrospective evaluation was performed of 168 adult patients who underwent a modi- fied Nuss PE repair with intraoperative transesophageal echocardiography from 2011 to 2014. Seven- teen patients with prior PE repair undergoing bar removal acted as controls. RESULTS: Mean agewas 33.0 years (range, 18 to 71 years). There was an increase in right atrium (15.1%), tricuspid annulus (10.9%), and right ventricular outflow tract (6.1%) size after surgery (all P , .0001). Right ventricular cardiac output measured in a subset of 42 patients improved by 38%. No change in chamber size or cardiac output occurred before and after bar removal surgery in the control group. CONCLUSIONS: Surgical correction of PE deformity caused a significant improvement in right heart chamber size and cardiac output. Ó 2015 Elsevier Inc. All rights reserved. Pectus excavatum (PE) is a common malformation of the chest wall with posterior depression of the sternum and adjacent costal cartilages. PE may cause physiologic symptoms and impairment by compression of the right heart chambers and limitation of diastolic filling. 1 The car- diac benefits of surgical correction on PE deformity have been debated. 2–15 Most studies report cardiopulmonary functional performance after surgical repair of PE. 2–14 The authors declare no conflicts of interest. * Corresponding author. Tel.: 480-301-4040; fax: 480-301-9700. E-mail address: naqvi.tasneem@mayo.edu Manuscript received April 10, 2015; revised manuscript June 15, 2015 0002-9610/$ - see front matter Ó 2015 Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.amjsurg.2015.07.006 The American Journal of Surgery (2015) 210, 1118-1125