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Case Report
Exercise motion analysis demonstrating correction of paradoxical chest wall motion following 3D printed sternal implant for sternal chondrosarcoma resection
1 Associate Research Scientist, Department of Medicine, Division of Pulmonary, Columbia University, New York, USA
2 Associate Dean, Faculty of Arts of Sciences, Fordham University, New York, USA
3 Professor of Clinical Cardiothoracic Surgery, Department of Surgery, Cornell University, New York, USA
4 Senior Software Engineer, Waymo, San Francisco, California, USA
5 Professor of Medicine, Department of Medicine, Division of Pulmonary, Columbia University, New York, USA
6 Associate Professor, Department of Medicine, Division of Pulmonary, Columbia University, New York, USA
Address correspondence to:
Aimee M Layton
PhD, 622 W 168th St., VC3-365, New York 10032,
USA
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Article ID: 100063Z12AL2019
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Layton AM, Swinarski D, Port JL, McCauley A, Thomashow BM, Bulman WA. Exercise motion analysis demonstrating correction of paradoxical chest wall motion following 3D printed sternal implant for sternal chondrosarcoma resection. J Case Rep Images Surg 2019;5: 100063Z12AL2019.ABSTRACT
Introduction: Chondrosarcoma is a rare bone cancer. This type of cancer often presents in long bones and it is extremely rare to find it in the sternum. Resection and reconstruction of a sternal chondrosarcoma are difficult and may lead to abnormal chest wall mechanics. We report a case where the patient underwent a curative resection of the chondrosarcoma with sternotomy and chest wall reconstruction with Gore-Tex mesh. As a result of the surgery she had pectus excavatum and persistent pain with inspiration. She then received the first threedimensional (3D) printed sternum implant in the United States. Cardiopulmonary exercise testing (CPET) and 3D motion analysis called optoelectronic plethysmography (OEP) were used to quantitatively assess her ventilatory mechanics and exercise ventilatory response pre- and post-3D printed implant.
Case Report: Optoelectronic plethysmography measured the patient’s ventilatory mechanics at rest and during exercise. Principal component analysis (PCA) analyzed the waveform of the marker movement. Results revealed preoperative complex, asynchronous chest wall motion by OEP 3D chest wall reconstruction, which included paradoxical movement of the sternal area. Postoperative testing revealed corrected chest wall movement. Specifically, the sternal body marker moved out of phase with the midline ventral chest (17% delay in movement) preoperatively; postoperatively the delay had decreased to 3%. Tidal volume of the rib cage improved postoperatively and compensatory abdominal movement decreased.
Conclusion: Optoelectronic plethysmography in conjunction with PCA provided isolated areas of the chest wall to be analyzed and abnormal movement quantified. Optoelectronic plethysmography and PCA were valuable tools in the assessment of abnormal chest wall mechanics and may be helpful in future planning for reconstructive chest wall surgery. Further work may determine the usefulness of OEP and PCA in other reconstructive chest wall surgeries.
Keywords: 3D printed prosthesis, Exercise chest wall movement, Optoelectronic plethysmography, Sternal chondrosarcoma
SUPPORTING INFORMATION
Author Contributions
Aimee M Layton - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
David Swinarski - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Jeffrey L Port - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Alexander McCauley - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Byron M Thomashow - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
William A Bulman - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
AcknowledgmentsWe would like to thank the patient in this study for her willingness to allow us to document her experience.
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2019 Aimee M Layton et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
