Fig. 1.

a AP Radiograph. The inferior vestigial ribs on the concave side appear too weak for VEPTR attachment. b 3D reconstruction of CT of chest and spine. The scan enables better visualization of the vestigial 11th and 12th ribs, which appear to be thick enough to carry the load of the VEPTR devices. c The coronal reconstruction of the CT scan. Note the anomalous insertion of the hemi-diaphragm proximally to the fused ribs on the concave side. This CT scan ruled out attachment of the hemi-diaphragm to soft tissue below the fused ribs, a flail hemi-diaphragm, which would have required a completely different operative strategy. d Supine lateral radiograph. Note kyphosis. It is not severe enough to warrant use of VEPTR II. VEPTR I is preferable for this age group, because it is more compact with greater expandability in the smaller sizes