Surgical Treatment Of Pectus Excavatum Research Articles

TECHNOLOGY OF MINIMALLY INVASIVE SURGICAL CORRECTION FUNNEL-SHAPED DEFORMATION OF THE CHEST IN CHILDREN

The most common method surgical treatment of pectus excavatum (PE) is thoracoplasty according by D.Nuss at the moment. But serious complications associated with trauma to the pericardium, blood vessels, and bleeding are known. Objective. Development of a modified technology surgical correction of pectus excavatum, which involves exclusively extrapleural passage of the plate, according to the individual size and shape of the deformation of the patient’s chest, in order to prevent intraoperative complications. Methods. 81 patients aged 10 to 17 years were involved in the study. A modified technology of extrapleural surgical correction of PE was performed. The plate was carried level of the VI–VII sternocostal joints through the formed through submuscular-extrapleural retrosternal tunnel from right to left under control of right-sided thoracoscopy. The plate was modeled according by individual deformation parameters chest. The analysis was carried out according to the following criteria: age, gender, type of deformity, Haller index, duration of surgery, intraoperative and early postoperative complications according by Clavien–Dindo classification. Results. The median age of patients was (13.8 ± 1.9) years, of which there were 65 (85.25 %) boys, 16 (19.75 %) girls. 48 (59.3 %) children were diagnosed with type I (symmetric) deformity, and 33 (40.7 %) with type II (asymmetric) according to the classification. The median Haller was (4.07 ± 0.62), which corresponds to 2–3 degrees. Differences in the degree of deformation in children of different sexes were not determined (р = 0.828). Impaired lung function was d iagnosed i n 55.55 % (n = 45), i mpaired h eart f unction — 40.74 % (n = 33). T he d uration of the o peration was on a verage (70.6 ± 15.4) minutes, from 50 to 110 minutes. Early postoperative complications were found in 5 (6.17 %) patients classified as grade I (mild) according to the Clavien–Dindo classification, which did not require additional medical or surgical correction. After the operation, the correction of chest deformation was on average (2.35 ± 0.22) according by Haller index, which was statistically significantly (р = 0.001) different from the initial level. Conclusions. The use of modified technology surgical correction of PE meets safety requirements and minimizes postoperative complications.

Magnetic resonance imaging in the evaluation of pectus excavatum

BACKGROUND: Magnetic resonance imaging is more often used to confirm the presence of pectus excavatum and assess compression changes in the heart at this level. AIM: To evaluate pectus excavatum preoperatively according to magnetic resonance imaging findings. MATERIALS AND METHODS: A retrospective evaluation of chest magnetic resonance imaging data of 38 patients (male, n=30; female, n=8) was performed. The average age was 19.9 years (±9 years).Cardiac magnetic resonance imaging was performed on a 1.5-T General Electric Optima MR450w GEM scanner with 2D-FIESTA-C pulse sequences, as well as functional assessment of the left and right ventricles. Parameters for surgical treatment of pectus excavatum were as follows: the Haller index, correction index, and sternum rotation angle. Statistical analysis of the relationship between the Haller index, correction index, and sternum rotation angle and ejection fraction of the right ventricle was conducted. A p-value 0.05 was considered significant. RESULTS: Moderate and severe pectus excavatum were found in 92% of the cases. No significant Pearson correlation was obtained between the Haller index and right ventricular ejection fraction (inspiratory and expiratory ejection fraction, p=0.777 and 0.798, respectively). The mean right ventricular ejection fraction was 46%. A correlation was noted between the Haller index and the correction index (p 0.05). The rotation angle of the sternum, which required modification of surgical intervention, was detected in 44.7% of patients. CONCLUSION: Magnetic resonance imaging is an informative diagnostic method for pectus excavatum pectus excavatum without radiation exposure and enables detailed preoperative assessment. A correlation was noted between the Haller index and the correction index (p 0.05). Magnetic resonance imaging revealed a decrease in the ejection fraction of the right ventricle.

Pectus excavatum. Tratamiento quirúrgico: ¿estructural o estético?

IntroductionPectus excavatum is a wall deformity that often warrants medical evaluation. In most cases, it's a purely visual aesthetic alteration, while in others, it comes with symptoms. Several surgical techniques have been described, but their outcomes are difficult to assess due to the heterogeneity of presentations and the lack of long-term follow-up. We present our experience as thoracic surgeons, assessing correction as either structural (remodeling of the thoracic cage through open surgery) or aesthetic (design and implantation of a customized 3D prosthesis). Material and methodsRetrospective observational study of the indication for surgical treatment of pectus excavatum carried out by a team of thoracic surgeons and the short- to mid-term results. ResultsBetween 2021 and 2023, we treated 36 cases surgically, either through thoracic cage remodeling techniques or with 3D prostheses. There were few minor complications, and the short- to mid-term results were positive: alleviation of symptoms or compression of structures when present, or aesthetic correction of the defect in other cases. ConclusionsSurgery for pectus excavatum should be evaluated for structural correction of the wall or aesthetics. In the former, thoracic cage remodeling requiring cartilage excision and possibly osteotomies is necessary. In the latter, the defect is corrected with a customized 3D prosthesis.

Pectus excavatum. Surgical treatment: Structural or aesthetic?

IntroductionPectus excavatum is a wall deformity that often warrants medical evaluation. In most cases, it’s a purely visual aesthetic alteration, while in others, it comes with symptoms. Several surgical techniques have been described, but their outcomes are difficult to assess due to the heterogeneity of presentations and the lack of long-term follow-up. We present our experience as thoracic surgeons, assessing correction as either structural (remodeling of the thoracic cage through open surgery) or aesthetic (design and implantation of a customized 3D prosthesis). Material and methodsRetrospective observational study of the indication for surgical treatment of pectus excavatum carried out by a team of thoracic surgeons and the short- to mid-term results. ResultsBetween 2021 and 2023, we treated 36 cases surgically, either through thoracic cage remodeling techniques or with 3D prostheses. There were few minor complications, and the short- to mid-term results were positive: alleviation of symptoms or compression of structures when present, or aesthetic correction of the defect in other cases. ConclusionsSurgery for pectus excavatum should be evaluated for structural correction of the wall or aesthetics. In the former, thoracic cage remodeling requiring cartilage excision and possibly osteotomies is necessary. In the latter, the defect is corrected with a customized 3D prosthesis.

Influence of psychosocial characteristics of patients and opinions of their relatives on indication for surgical treatment of pectus excavatum.

To assess the subjective experience of patients and their parents or relatives about the existing pectus excavatum deformity and to contribute to the definition of indications for surgical treatment of this deformity. The initial sample of psychosocial characteristics consisted of self-assessments and observations of patients (and parents) regarding their health, self-image, health care, possible environmental response to their physical appearance, expectations regarding treatment. A modified version of the original Nuss questionnaire on quality of life was used in the psychological part of the examination. The study included a sample of 58 patients aged 10 to 30 years, and a sample of 58 family members of the patient (parents, relatives). The experience of poor emotional status, withdrawals, and bad self-image in patients older than 15 years than younger were significant. The tendency for female patients to have a worse experience is pronounced and significant. The largest percentage of parents have an 'indecisive' or 'weakly expressed' attitude towards surgery. Parents at a significantly higher rate show greater concern for female children. A systematic evaluation of the psychosocial perception of patients and their relatives (who will consent for the operation) may be a useful diagnostic assessment before correcting an anterior chest wall malformation.

Surgical treatment of pectus excavatum after cardiac surgery: Wung procedure + Wang procedure + Wenlin procedure

We performed surgery on a patient with pectus excavatum after cardiac surgery recently. The patient was a 11-year-old boy. At the age of 3, he underwent surgery for congenital heart disease. The median sternotomy was employed. The heart surgery was successful, but there was a depression in the anterior chest wall after the operation, which was diagnosed as secondary pectus excavatum. The patient had no discomfort after operation, but was not satisfied with the chest wall appearance. He was admitted to our hospital for surgery. During the operation, three kinds of procedures were used for correction, including Wung procedure, Wang procedure and Wenlin procedure. Three steel bars were used during the operation, and satisfactory results were obtained. Our experience shows that for patients with pectus excavatum after cardiac surgery, Nuss procedure is not only high-risk, but also difficult to achieve success. However, if other procedures are used for correction, satisfactory results can often be obtained.

The highest level of surgical treatment of pectus excavatum

Pectus excavatum is the most common thoracic deformity, and there are many surgical methods used in clinic. Almost all the previous operations were limited to one kind of procedure. The completion of the operation will directly affect the effect of the treatment of pectus excavatum. After long-term clinical practice, we found that pectus excavatum can be treated with multiple methods at the same time. The use of these methods can completely correct the deformity and achieve the most satisfactory results. Thus, we have a new understanding of the treatment of this deformity. The treatment level of pectus excavatum itself is not the same as the level of mastering a certain surgical method. The highest level of pectus excavatum surgery is to make the most perfect treatment for this deformity, and it is absolutely not to skillfully complete a certain operation.

Pectus excavatum in children

Objective. To study the effect of the degree of pectus excavatum in children on the severity of clinical manifestations, as well as the function of the chest organs before and after surgical treatment.Materials and methods. The study included 36 patients with II-III degree pectus excavatum undergoing surgical treatment and examination at the Orthopedics and Traumatology Department of the Gomel Regional Children’s Clinical Hospital from January 2019 to September 2021. All the patients were examined in clinical setting with laboratory and instrumental methods, were performed electrocardiography, echocardiography, Holter monitoring, the study of the function of external respiration, computed tomography of the chest.Results. As a result of the conducted studies, it has been found that the degree of thoracic deformity in children affects the severity of clinical and functional changes in the chest organs.Conclusion. The performed study has showed that the surgical treatment of pectus excavatum contributes to the elimination of functional disorders in the work of the heart and respiratory organs.

Еволюція методик хірургічної корекції лійкоподібної деформації грудної клітки в дітей: одноцентровий досвід

Pectus excavatum (PE) in children is the most common pathology among orthopedic diseases of the anterior chest wall. Today in the world the main direction of scientific research in the surgical correction of this pathology is safety during surgery for the patient and the introduction of minimally invasive techniques. Purpose – to conduct a comparative analysis of the results of thoracoplasty in children with PE using different surgical techniques to reduce trauma and duration of surgery and blood loss; to study the optimal correction results to accelerate psycho-physical adaptation after the Nuss procedure. Materials and methods. The treatment of 289 patients operated on for PE in the orthopedic and traumatology department of National Children’s Specialized Hospital «OKHMATDYT» were analyzed. According to the methods of thoracoplasty used, patients were divided into 3 groups. In the first group (n=112) PE correction was performed using Nuss operation with subxiphoid access and tactile control during the retrosternal bar placement; in the second group (n=79) Nuss procedure was performed under thoracoscopic control, where one retrosternal T-shaped bar with additional lateral stabilizer was implanted and fixed on the ribs with a resorbable suture or wire; in the third group (n=98) surgical treatment of PE was performed using the Nuss procedure under thoracoscopic control using a fixator consisting of two retrosternal bars-arches, which are interconnected by lateral bars, the «Bridge» technique. Results. When using thoracoscopic control and temporary sternum elevation by modificated «Park crane» during the correction of PE, the time of surgery and blood loss was reduced. No rotations of the fixator throughout the observation period and lower postoperative pain syndrome were observed in patients of the 3rd group, who underwent corrections with the «Bridge technique». Conclusions. The technique of minimally invasive correction of pectus excavatum (MIRPE), Nuss operation, using thoracoscopic control and temporary elevation of the sternum during pectus bar placement is a safe and effective method of thoracoplasty. The use of two plates (the «Bridge» system) during minimally invasive correction is the operation of choice for adolescent children with funnel chest deformities. The research was carried out in accordance with the principles of the Helsinki declaration. The study protocol was approved by the Local ethics committee of all participating institution. The informed consent of the patient was obtained for conducting the studies. No conflict of interest was declared by the authors. Key words: pectus excavatum; chest deformity; Nuss operation, surgery, pediatrics, thoracoplasty, results.

Особенности оптимизации хирургического лечения воронкообразной деформации грудной клетки с использованием торакометрии

Актуальность. Воронкообразная деформация грудной клетки является наиболее частой из всех врожденных аномалий грудной клетки. Степень и характер деформации грудной клетки у детей и взрослых определяется с помощью метода торакометрии, который дает представление о глубине деформации и ширине грудной клетки, ее косых размерах, торакальном индексе, а также позволяет проследить эти показатели в динамике. Цель исследования: провести анализ результатов хирургического лечения воронкообразной деформации грудной клетки по методике Nuss и определить пути оптимизации лечения с помощью торакометрии. Материалы и методы. В исследовании представлены результаты обследования и лечения 85 больных с воронкообразной деформацией грудной клетки, среди которых 58 пациентам выполнена операция по методике Nuss (в 2017–2019 гг.), 27 пациентам — изъятие фиксаторов из грудины (оперированных по методике Nuss в 2016 г.). Результаты. Среди 27 больных, которым была проведена коррекция воронкообразной деформации по методике Nuss в 2016 году, у 24 (89,9 %) больных результат был положительным: разница при вдохе и выдохе по сагиттальным и косым размерам грудной клетки не превышала 1 см и отвечала физиологической норме. Индекс J. Gizicka в послеоперационном периоде отмечался в пределах 0,82–1,0, что свидетельствует о хорошей коррекции формы грудной клетки. У 3 (11,1 %) пациентов наблюдался отрицательный результат: у 2 пациентов произошел рецидив воронкообразной деформации, что требовало проведения повторного оперативного вмешательства, у 1 больного наблюдалось образование килевидной деформации. Среди 58 больных, оперированных первично в 2017–2019 годах, у 55 (94,8 %) получен хороший результат и у 3 (5,2 %) пациентов — неудовлетворительный результат, который проявлялся в провороте фиксатора. Выводы. Проведение торакометричного исследования у больных с воронкообразной деформацией позволяет оценить результаты хирургического лечения в разные сроки после операции, определить степень потери коррекции деформации по сравнению с состоянием сразу после операции.

Наш досвід застосування торакопластики за Нассом як методу корекції лійкоподібної деформації грудної клітки

Актуальність. Лійкоподібна деформація грудної клітки (ЛДГК) — дефект її розвитку, що нерідко є про­явом дисгістогенетичних синдромів. У 1998 р. Nuss з колегами повідомили про новий метод мінімально інвазивної корекції ЛДГК. Безумовними перевагами методу Насса є мінімальна травматичність і максимальний косметичний ефект. Разом із тим багато авторів вказують на досить високу частоту ускладнень при використанні даної методики. Мета: оцінити результати хірургічного лікування лійкоподібної деформації грудної клітки за методом Насса. Матеріали та методи. Обстежено 97 пацієнтів з ЛДГК, яким проведена мінімально інвазивна корекція за методом Насса. Дослідження проведено в клініці хірургії хребта ДУ «Інститут травматології та ортопедії НАМН України» в період з 2015 по 2018 р. Результати. У 83 (85,5 %) пацієнтів нам вдалося досягти ідеального косметичного результату. У 88 (90,7 %) використовували один фіксатор, у 6 (6,1 %) — 2 фіксатори, у 3 (3,2 %) — 3 фіксатори. Серед ускладнень у 10 (10,3 %) визначали наявність пневмотораксу, у 2 (2,06 %) — гемоторакс із подальшим виконанням плевральної пункції. Пневмонію діагностували у 2 (2,06 %) пацієнтів, плевральний випіт — у 2 (2,06 %), емпієму — у 1 (1,03 %), сірому — у 1 (1,03 %), глибоку інфекцію — у 1 (1,03 %). Один пацієнт (1,03 %) переніс повторну операцію через вивих фіксатора. На даний час фіксатори були видалені у 46 пацієнтів (47,4 %), кінцеві результати цих пацієнтів визначалися як хороші безпосередньо під час виписки й при повторному спостереженні через 1 місяць. Висновки. Торакопластика за Нассом є найменш травматичною операцією для корекції ЛДГК і може бути застосована в дітей із раннього віку. У свою чергу, ми вважаємо оптимальним віком для операції 13–16 років. Обґрунтуванням для цього є те, що зміни з боку серця й легенів у цьому віці оборотні, а фіксатор продовжує залишатися аж до закінчення росту, що мінімізує можливість рецидиву деформації.

Surgical correction of pectus excavatum in an adult with the use of thoracoscopic intercostal nerve cryoablation

Despite the improvement of the surgical approach for the correction of pectus pectus deformity, the reduction of the invasiveness of the intervention and the use of modern technologies, the optimal technology for the prevention and treatment of postoperative pain has not yet been determined. We have presented an alternative approach to regional analgesia for surgical treatment of pectus excavatum.

Nuss Procedure for Pectus Excavatum: A Comparison of Complications Between Young and Adult Patients

The Nuss procedure is the gold standard surgical treatment for pectus excavatum in young patients. Its use in adults has also been described, although it may be associated with increased postoperative morbidity resulting from higher chest wall rigidity. This study aimed to examine the risk of complications after the Nuss procedure in adult patients compared with young patients with pectus excavatum. This single-center retrospective cohort study evaluated all patients who underwent the Nuss procedure between 2006 and 2018. Patients were stratified by age as young (≤24 years old) and adult (>24 years old). The primary end point was the occurrence of perioperative or postoperative complications, subdivided into major (Clavien-Dindo class IIIa or higher) and minor (less severe than Clavien-Dindo class III). Between-group differences were analyzed using the Mann-Whitney U and the χ2 test with post hoc analysis. A total of 327 participants were included, 272 in the young group (median age, 16 years; interquartile range [IQR], 15 to 18 years; range, 11 to 24 years) and 55 in the adult group (median age, 32 years; IQR, 27 to 38 years; range, 25 to 47 years). The median Haller index was similar between groups (young, 3.7; IQR, 3.2 to 4.4 vs adult,3.6; IQR, 3.0 to 4.3; P= .44). The median follow-up was 34 and 36 months, respectively. The incidence of major complications was comparable between young and adult participants (P= .43). Minor complications occurred more often among adults (young, 4% vs adult, 11%; P= .002). Chronic postoperative pain was the only minor complication with a significant difference in incidence (young, 1% vs adult, 7%; P= .008). The Nuss procedure is a safe surgical treatment for pectus excavatum in both young and adult patients. The risk of major complications is comparable. However, adults more often have chronic pain.

Numerical investigation of the sternoclavicular joint modeling technique for improving the surgical treatment of pectus excavatum

It is now common to perform the Nuss procedure as a surgical treatment for pectus excavatum. As several types of detailed surgical methods exist as part of the Nuss procedure, studies are currently being conducted to verify their relative superiority via computerized biomechanical methods. However, no studies have considered the influence of sternoclavicular joints on the simulations of the Nuss procedure. Accordingly, this study aims to demonstrate the influence of these joints by comparing the clinical data with the finite element analysis data. Scenarios were set by classifying the movement of the joints based on the constraints of translation and rotation in the coordinate plane. The analyses were performed by applying the set scenarios to the constructed finite element model of a chest wall. The sternal displacement, Haller index, and equivalent stress were obtained from the analysis, and the data were compared with the data of the postoperative patient. When the translation of the anterior direction on the chest wall was constrained, the result obtained thereof was found to be similar to those obtained in the actual surgery. It is suggested that more accurate results can be obtained if the influence of the sternoclavicular joints is considered.

Rib deformity correction in children with pectus excavatum

The article is devoted to a comparative analysis of the surgical treatment of pectus excavatum. A prospective, single-center, non-randomized study of the immediate results of the correction of pectus excavatum in children and adolescents is presented.
 Material and methods. The treatment results of 40 patients (27 men and 13 women) aged 3 to 18 years, operated between March 2005 and March 2016 were analyzed. All patients were examined according to the standard algorithm: chest MSCT, spirometry. All patients were divided into 2 groups. Group I patients operated on by the open resection method with plastic surgery of the costal arches (n=27). Group II patients operated with the use of minimally invasive technology according to NUSS, which does not provide for correction of deformation of costal arches (n=13).
 Results. In group II, significantly less blood loss was noted (35.7 ml versus 137 ml in group I, p0.05), shorter duration of surgery (230 min versus 27.5 min in group I, p0.05). It is worth noting the earlier discharge from the hospital in patients with minimally invasive correction of deformity.
 Conclusion. Minimally invasive thoracoplasty is an effective way to correct pectus excavatum in children and adolescents, which can significantly reduce the duration of surgery and intraoperative blood loss, is comparable in basic terms with reconstructive surgery, but inferior due to the lack of correction of deformation of the rib arches.

Simultaneous surgical treatment for pectus excavatum combined with congenital cardiothoracic diseases

To study the methods and principles for simultaneous treatment in the children with pectus excavatum (PE) combined with congenital cardiothoracic diseases. Methods: The medical records of all children, who underwent simultaneous repair of PE combined with congenital cardiothoracic diseases, were retrospectively reviewed in Hunan Children's Hospital from January 2007 to September 2018. The patients were divided into a PE combined with congenital heart disease (CHD) group (n=17) and a PE combined with thoracic disease group (n=10). The repair with a custom-made sternal lifting device, a Nuss repair, were performed in the treatment of PE, and the correction of the CHD was performed by heart open surgery using cardiopulmonary bypass (through sternotomy or right infra-axillary thoracotomy) or by transcatheter closure under echocardiography or X-ray-guided percutaneous intervention in the PE combined with CHD group. The children in the PE combined with thoracic disease group underwent thoracic surgery plus Nuss procedure concurrently. Results: All 27 pediatric patients underwent simultaneous repair of the PE combined with congenital cardiothoracic diseases. In the PE combined with CHD group, the duration of hospital stay ranged from 8.0 to 25.0 (13.2±4.8) days. Two patients had delayed healing of the surgical wound and 1 patient developed a small left pleural effusion postoperatively. In the PE combined with thoracic disease group, the duration of hospital stay ranged from 10.0 to 34.0 (19.9±7.5) days. One patient was complicated with chylothorax and 2 patients were complicated with pleural effusionin. The treatment for the patients in the 2 groups was satisfactory. No severe complications like surgical death, severe bleeding, chest organ injuries, and implant rejections were observed. Conclusion: According to the characteristics of patients, individualized programs should be selected in order to correct children's PE combined with congenital cardiothoracic diseases in the same period, which are safe, effective and can avoid the risk of multiple operations and anesthesia, and can reduce the financial burden of family.

Vacuum bell treatment of pectus excavatum: An early North American experience

PurposeConservative treatment of pectus excavatum with a vacuum bell device may be an attractive alternative to surgical repair. We describe an early North American experience with this device. MethodsProspectively maintained chest wall clinic registries from two institutions were reviewed to identify pectus excavatum patients ≤21 years treated with the vacuum bell from 2013 to 2017. Multivariate linear regression was used to compare mean improvements in deformity-depth and Haller Index between groups of patients based on age and usage metrics (hours/day and days/week). ResultsThirty-one patients with a median age of 14 years received treatment with the device. Mean follow-up duration was 18 months. Median depth and Haller Index at treatment onset were 2.3 cm and 3.9, respectively. Improvements in deformity-depth were superior with device usage >2 h/day (p < 0.01) and daily use (p < 0.01). After adjusting for compliance, younger age of treatment onset was associated with greater improvement in Haller Index but not deformity depth. ConclusionOur prospective early North American experience found the vacuum bell to be a potential alternative to surgical treatment for pectus excavatum. Longer usage periods in a daily frequency are associated with best results. Type of studyTreatment study; case series with no comparison group. Level of evidenceLevel IV.

Досвід хірургічного лікування лійкоподібної деформації грудної клітки у дітей

Досвід хірургічного лікування лійкоподібної деформації грудної клітки у дітей

Evaluating interest in narrative therapy for decision making about pectus excavatum treatment.

The decision to proceed with surgical treatment for pectus excavatum (PE) is rarely clear-cut. Patients interested in treatment are referred for evaluation by numerous different specialists, but psychosocial counselling is currently not included in this process. Our objective was to assess whether PE patients would be interested in formal assistance with the decision-making process surrounding PE surgery using narrative therapy principles. Ninety-seven untreated PE patients at 5 different institutions in 4 countries completed a questionnaire consisting of 13 questions, with 3 questions specifically evaluating interest in narrative therapy. Eighty-two percent of participants were interested in narrative therapy to assist with the decision-making process surrounding PE surgery. Individuals most interested in narrative therapy tend to be more interested in correction (P < 0.05) to improve the way they feel about their body (P < 0.05). The majority of PE patients are interested in narrative therapy to aid the decision-making process about treatment. We propose that narrative therapy should be offered to PE patients during the treatment evaluation process to address the psychosocial difficulties associated with PE and the surgical decision-making process overall. Future studies should assess the effectiveness of this interdisciplinary model.

Endovascular treatment for hemothorax via contralateral internal thoracic artery branch after Nuss procedure – A case report

Abstract The Nuss procedure is performed widely as a standard surgical treatment for pectus excavatum. Compared to conventional methods, the Nuss procedure excels in cosmetic terms and involves fewer complications. A 14-year-old boy developed right hemothorax with a sudden shock one month after the Nuss procedure. We identified the bleeding from left internal thoracic artery (ITA) branch and achieved hemostasis by endovascular coil embolization. To the best of our knowledge, this is the first to report that the ITA on the contralateral side of the hemothorax was responsible for the bleeding.