title: Cardiac magnetic resonance imaging for perioperative evaluation of sternal eversion for pectus excavatum.
abstract: OBJECTIVE
  Pectus excavatum is associated with varying degrees of exercise intolerance and symptomatology. Various forms of evaluation have been inconsistent in identifying objective data for correlation with symptoms. Cardiac magnetic resonance (CMR) imaging provides a promising method for delineating the anatomical and physiological components of pectus excavatum as well as measuring the results of surgical repair.
  
  
  METHODS
  Six patients with symptomatic pectus excavatum underwent preoperative evaluation with CMR. All patients had successful, uncomplicated repair of pectus excavatum using the sternal eversion technique. At the first postoperative visit, all patients underwent postoperative evaluation with CMR. Pre- and postoperative CMR measurements were compared for each patient.
  
  
  RESULTS
  Preoperative CMR demonstrated evidence of anatomical and dynamical compression of the heart in all patients. After surgery, all patients showed improvement on postoperative CMR. Five of the 6 (83%) patients had complete relief of right ventricular compression, and 5 of the 6 (83%) patients had relief of left atrial compression. The degree of antero-posterior chest wall narrowing was also markedly improved, with an average postoperative vs preoperative Haller index of 3.2 (range, 2.7-3.8) vs 5.0 (range, 4.0-5.9).
  
  
  CONCLUSIONS
  After surgical correction of pectus excavatum with the sternal eversion technique, CMR demonstrates improvement in both anatomical chest wall contour and cardiac performance. Sternal eversion provides the most complete anatomical correction and greatest relief of internal cardiac compression. We recommend CMR as the definitive modality for evaluation of patients with pectus excavatum, as this modality shows that the primary underlying physiological abnormality in pectus excavatum is cardiac compression.
authors.affiliation: Division of Cardiovascular and Thoracic Surgery, Intermountain Medical Center, Murray, UT 84107, USA.
authors.forename: Christopher M
authors.initials: CM
authors.lastname: Humphries
authors.forename: Jeffery L
authors.initials: JL
authors.lastname: Anderson
authors.forename: Jean H
authors.initials: JH
authors.lastname: Flores
authors.forename: John R
authors.initials: JR
authors.lastname: Doty
mesh_terms: D005660:Funnel Chest / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods*; D059035:Perioperative Period / Q000379:methods; D013249:Sternum / Q000473:pathology / Q000503:physiopathology / Q000601:surgery*; D019616:Thoracic Surgical Procedures; D016896:Treatment Outcome
keywords: Cardiac physiology; Chest wall; Mediastinum; Pectus excavatum