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Conventionally, the Syncardia total artificial heart system is implanted based on the distance from the anterior aspect of the 10th thoracic vertebra to the sternum and the patient's body surface area. However, this criterion does not account for chest wall musculoskeletal deformities. This case report describes a patient with a pectus excavatum who developed compression of the inferior vena cava after Syncardia total artificial heart implantation and how transesophageal echocardiography guided chest wall surgery to accommodate the total artificial heart system.<\/jats:p>","DOI":"10.1177\/10892532231157529","type":"journal-article","created":{"date-parts":[[2023,2,20]],"date-time":"2023-02-20T04:31:51Z","timestamp":1676867511000},"page":"239-243","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Refractory Hypotension During Implantation of a 70\u00a0mL Total Artificial Heart in a Patient With Pectus Excavatum: A Case Report"],"prefix":"10.1177","volume":"27","author":[{"given":"Brendon","family":"Hart","sequence":"first","affiliation":[{"name":"Department of Anesthesiology, The Ohio State University Wexner Medical Center, Columbus, OH, 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