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Külcü K, Elenbaas TW, Nguyen DT, Verhees RP, Mihl C, Verberkmoes NY, van Straten AH, Soliman Hamad MA. Patency of the internal mammary arteries after removal of the Nuss bar: an initial report. Interact Cardiovasc Thorac Surg 2014; 19:6-9. [DOI: 10.1093/icvts/ivu083] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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202
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Hikiji W, Fukunaga T. Fatal broncho-pneumonia of an infant with arthrogryposis multiplex congenita (AMC). Leg Med (Tokyo) 2014; 16:157-60. [PMID: 24657039 DOI: 10.1016/j.legalmed.2014.02.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2013] [Revised: 01/25/2014] [Accepted: 02/28/2014] [Indexed: 10/25/2022]
Abstract
Arthrogryposis multiplex congenita (AMC) is a heterogenous group of disorders characterized by multiple joint contractures with an estimated frequency of 1 in 3000-5100 livebirths. The authors present a case of an 11-month-old infant with AMC who died due to severe pneumonia. The deceased had no significant anomaly except for the stated orthpaediatric deformities, and the long-term outcome was expected to be positive. The only remarkable past medical history was respiratory syncytial virus (RS) infection at 6-months old which had taken a few days for a complete recovery. Onset of high fever was observed 3 days prior to her death and she was found in a state of cardiopulmonary arrest in bed by her father in an early morning. Forensic autopsy confirmed the pathohistological diagnosis of severe broncho-pneumonia. The presence of scoliosis and funnel chest was considered to be attributable to the disability to turn herself over and excrete sputum sufficiently, leading to a fatal respiratory complication. This paper stresses the possibility of distal arthrogryposis type of AMC becoming contributory to death despite the initial optimistic prognosis, as well as the importance of postmortem investigation in unexpected fatal cases.
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Affiliation(s)
- Wakako Hikiji
- Tokyo Medical Examiner's Office, Tokyo Metropolitan Government, 4-21-18 Otsuka, Bunkyo-ku, Tokyo 112-0012, Japan.
| | - Tatsushige Fukunaga
- Tokyo Medical Examiner's Office, Tokyo Metropolitan Government, 4-21-18 Otsuka, Bunkyo-ku, Tokyo 112-0012, Japan
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Clinical Results and Patient Satisfaction after Pectus Excavatum Repair Using the MIRPE and MOVARPE Technique in Adults. Plast Reconstr Surg 2013; 132:1591-1602. [DOI: 10.1097/prs.0b013e3182a97dc1] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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205
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Muhammad MIA. Thoracoscopic repair of pectus excavatum using different bar stabilizers versus open repair. Asian Cardiovasc Thorac Ann 2013; 22:187-92. [DOI: 10.1177/0218492313487180] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives To identify the preoperative characteristics and compare operative variables and postoperative outcomes in adult patients with pectus excavatum undergoing thoracoscopic repair using different bar stabilizers or open surgical repair. Methods 31 patients were randomly divided into 3 groups: group A was 9 patients who underwent a modified Ravitch repair, group B was 11 patients who underwent video-assisted thoracoscopic repair using metal stabilizers, and group C was 11 patients who underwent video-assisted thoracoscopic repair using absorbable stabilizers. Preoperative, intraoperative, and postoperative variables and mortality were compared among groups. Results In all groups, preoperative variables were well-matched for age, sex, and Haller index. Operative time was significantly longer in group A. The postoperative length of hospital stay was significantly shorter in group A. Postoperative complications occurred in 7 (22.6%) patients, mostly in groups B and C. All patients were satisfied with the cosmetic result. Conclusions Repair of pectus excavatum in adult patients can be performed effectively either through an open surgical technique or thoracoscopy, with no intraoperative complications and excellent immediate results, but video-assisted thoracoscopic repair using metallic or absorbable bar stabilizers gives a better cosmetic result; however, absorbable bar stabilizers are more vulnerable and break more easily than metal stabilizers.
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Affiliation(s)
- Magdi Ibrahim Ahmad Muhammad
- Department of Cardio-Thoracic Surgery, Faculty of medicine, Suez Canal University, Egypt
- Department of Thoracic Surgery, King Fahad Hospital, Al-Madina Al-Munawara, Saudi Arabia
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Albertal M, Vallejos J, Bellia G, Millan C, Rabinovich F, Buela E, Bignon H, Martinez-Ferro M. Changes in chest compression indexes with breathing underestimate surgical candidacy in patients with pectus excavatum: a computed tomography pilot study. J Pediatr Surg 2013; 48:2011-6. [PMID: 24094949 DOI: 10.1016/j.jpedsurg.2013.01.044] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Revised: 01/18/2013] [Accepted: 01/29/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Haller Index (HI) ≥3.25 by computed tomography (CT) at end-inspiration has been used to indicate surgical correction in patients with pectus excavatum. However, chest wall diameters vary with breathing and may modify HI values and surgical indications. The aim of our study was to report the changes in HI with breathing and their impact in the surgical indication rates. METHODS Thirty six patients with pectus excavatum underwent chest CT evaluation at both end-inspiration and end-expiration. HI was derived by dividing the transverse diameter (TD) of the chest by the anteroposterior diameter (APD). Cardiac compression index (CCI) was then calculated by dividing the cardiac TD by the APD. RESULTS Mean patient age was 19 ± 7 years old and 86.8% were males. From end-inspiration to end-expiration, large changes in APD values corresponded to large changes (29.6%) in HI values. CCI increased significantly during end-expiration, primarily driven by an increase on the cardiac TD. Surgical indication was found in 71% and 91% of patients during end-inspiration and end-expiration, respectively (p<0.05). CONCLUSIONS This study showed that the severity indexes of the pectus excavatum were all significantly more severe at end-expiration than at end-inspiration, leading to an increase in surgical candidacy. We therefore recommend performing the CT at end-expiration.
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Affiliation(s)
- Mariano Albertal
- Department of Pediatric Surgery, Fundacion Hospitalaria, Private Children's Hospital, Buenos Aires, Argentina
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207
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Hanna WC, Ko MA, Blitz M, Shargall Y, Compeau CG. Thoracoscopic Nuss Procedure for Young Adults With Pectus Excavatum: Excellent Midterm Results and Patient Satisfaction. Ann Thorac Surg 2013; 96:1033-6; discussion 1037-8. [DOI: 10.1016/j.athoracsur.2013.04.093] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2013] [Revised: 04/08/2013] [Accepted: 04/10/2013] [Indexed: 11/15/2022]
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Pectus excavatum: a comparison of the Ravitch repair with the Nuss thoracoscopic technique with a standard metal bar or an absorbable bar. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2013; 8:206-10. [PMID: 23989814 DOI: 10.1097/imi.0b013e3182a3659c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Although pectus excavatum repair has evolved to a minimally invasive technique in prepubescent patients, the best approach in adults is less clearly understood. The aim of this study was to identify the preoperative characteristics, operative variables, and postoperative outcomes in adult patients with pectus excavatum undergoing thoracoscopic repair using different bar stabilizers compared with the open surgical repair. METHODS We conducted a prospective study between July 2009 and July 2012 in a single institution. Thirty-one patients (26 men and 5 women) aged 18 to 35 years were randomly assigned into three groups: group A, 9 patients underwent modified Ravitch repair; group B, 11 patients underwent video-assisted thoracoscopic repair using metal stabilizers; and group C, 11 patients underwent video-assisted thoracoscopic repair using absorbable stabilizers. Preoperative, intraoperative, and postoperative variables are compared between all groups. RESULTS In all groups, the preoperative variables were well matched for age, sex, and Haller index. Operative time was 2 hours longer in group A (P = 0.0001). There was no intraoperative complication. Length of hospital stay was 4 days shorter in group A. Morbidity was 23% and composed of pneumothorax (three), wound seroma (two), pleural effusion (one), and stabilizer break (one), occurring more frequently in groups B and C. There was no perioperative mortality. All patients were satisfied with the cosmetic results. CONCLUSIONS Repair of pectus excavatum in adult patients can be performed effectively through either open surgical technique or thoracoscopy, with no intraoperative complications and with excellent immediate results. Although the operative time for the Ravitch repair was longer, the hospital stay was significantly shorter than that for the video-assisted method.
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Ravenni G, Actis Dato GM, Zingarelli E, Flocco R, Casabona R. Nuss procedure in adult pectus excavatum: a simple artifice to reduce sternal tension. Interact Cardiovasc Thorac Surg 2013; 17:23-5. [PMID: 23575757 PMCID: PMC3686398 DOI: 10.1093/icvts/ivt136] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2012] [Revised: 01/25/2013] [Accepted: 02/04/2013] [Indexed: 11/12/2022] Open
Abstract
Nowadays the Nuss operation represents the standard surgical choice for pectus excavatum repair in children and teenagers. Some concerns have been raised regarding its applicability in adults, as compared with younger patients, in view of the higher rate of complications after surgery. We describe an easy trick that has been performed on a 36-year old man with a moderate pectus excavatum after an unsatisfactory Nuss procedure. It consisted of a T-shaped partial anterior sternotomy, performed after positioning of the stainless steel bar, in order to promote a hinge mechanism of the sternum to reduce the tension over the reinforcement. This procedure was successful with well-controlled postoperative pain and great patient satisfaction. No complications were recorded at 1-year follow-up. In our opinion, this simple trick could represent a valid surgical option for pectus excavatum repair in late adolescents and adults to obviate the occurrence of major sternal tension.
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Sesia SB, Haecker FM, Shah B, Goretsky MJ, Kelly RE, Obermeyer RJ. Development of metal allergy after Nuss procedure for repair of pectus excavatum despite preoperative negative skin test. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2013. [DOI: 10.1016/j.epsc.2013.05.004] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
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211
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Long LH, Fu LJ, Jing Z, Qiang ZW. Modified Nuss procedure is a safe choice for recurrent pectus excavatum after previous open repair experience of 26 cases. Pediatr Surg Int 2013; 29:597-600. [PMID: 23588845 DOI: 10.1007/s00383-013-3294-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 02/28/2013] [Indexed: 11/26/2022]
Abstract
PURPOSE This study is aiming to investigate the feasibility and effect of applying modified Nuss procedure on recurrent pectus excavatum following previous open repair. METHODS By retrospectively reviewing patients of pectus excavatum enrolled in our department from July 2007 to August 2012, we find 27 cases of recurrent PE who received open repair previously. Twenty-six patients received Nuss repair, while one patient refused. Relevant data are collected and processed. A 3-month follow-up after operation is also reviewed. Analysis of data is conducted. RESULTS Twenty-six recurrent patients underwent modified Nuss procedure safely. Pneumothorax after operation occurred in one case. Pleural effusion occurred for every case, most were mild in quantity except two cases whose pleural effusion were moderate. All patients left hospital within 2 weeks after operation except one patient who died of respiration failure. Mean postoperative Haller Index is significantly different from the preoperative one. Cosmetic effect was excellent for 5 cases, good for 15 cases, moderate for 6 cases. In a 3-month follow-up, no bar displacement or rejection happened and pleural effusion was completely absorbed. CONCLUSION Although technically challenging, Nuss procedure is feasible and good for recurrent PE after open repair.
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Affiliation(s)
- Liang Hai Long
- Department of Thoracic Surgery, General Hospital of Beijing Military Region, Dong Cheng District, Nan Men Cang 5#, Beijing 100700, People's Republic of China.
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212
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A simple technique for pectus bar removal using a modified Nuss procedure. J Pediatr Surg 2013; 48:1137-41. [PMID: 23701795 DOI: 10.1016/j.jpedsurg.2013.01.052] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Revised: 01/16/2013] [Accepted: 01/31/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND Although the Nuss procedure has been widely accepted as the standard procedure for the repair of pectus excavatum in children, adolescents, and even adults, few reports have documented the bar removal procedure as a whole. In this study, we retrospectively evaluated the safety and efficacy of a modified Nuss bar removal procedure. METHODS A total of 186 patients undergoing bar removal after the Nuss procedure were included in this study. All cases had unilateral incision (metallic stabilizers were used on one side in all patients). Patients were laid down in the supine position and given general anesthesia through a single lumen tracheal tube or laryngeal mask. The bar was pulled out along the thoracic wall without straightening or overturning through the original right incision. RESULTS The mean operation time for bar removal was 12 min (range: 8-20 min). The mean operative blood loss was 5 mL (range: 3-20 mL). No patient suffered from an infection at the incision after surgery, but 3 patients (1.6%) developed mild pneumothorax. All patients were discharged from the hospital within a day after the surgery. The bar in 133 patients (71.5%) was removed in 2 years after Nuss procedure but more than two and a half years in 53 patients (28.5%). The patients were followed up for 4 to 48 months with a mean of 21.4 months. No recurrence was observed during the follow-up period. CONCLUSIONS The Nuss bar can be safely and easily removed in 2 years or longer after the Nuss procedure. Our study suggests that, after removing the metallic stabilizer, the bar should be turned with the flipper to loosen it from the surrounding fibrous capsule and then pulled out along the original surgical incision without bending or turning.
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Magdi Muhammad IA. Pectus Excavatum: A Comparison of the Ravitch Repair with the Nuss Thoracoscopic Technique with a Standard Metal Bar or an Absorbable Bar. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2013. [DOI: 10.1177/155698451300800306] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ibrahim Ahmad Magdi Muhammad
- Department of Cardio-Thoracic Surgery, Faculty of Medicine, Suez Canal University, Ismailia, Egypt; and Department of Thoracic Surgery, King Fahad Hospital, Al-Madina Al-Munawara, Saudi Arabia
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Kelly RE, Quinn A, Varela P, Redlinger RE, Nuss D. Dismorfología de las deformidades de la pared torácica: distribución de frecuencias de los subtipos de pectus excavatum típico y subtipos poco comunes. Arch Bronconeumol 2013; 49:196-200. [DOI: 10.1016/j.arbres.2012.09.013] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2012] [Revised: 08/10/2012] [Accepted: 09/10/2012] [Indexed: 11/29/2022]
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Complications related to the Nuss procedure: minimizing risk with operative technique. J Pediatr Surg 2013; 48:1044-8. [PMID: 23701780 DOI: 10.1016/j.jpedsurg.2013.02.025] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2013] [Accepted: 02/03/2013] [Indexed: 11/22/2022]
Abstract
INTRODUCTION Pectus Excavatum (PEx) is the most frequent congenital chest wall deformity; surgical correction has a complication rate of 10%-50%. The purpose of this study was to evaluate outcomes in a recent cohort of pediatric patients from a single institution and investigate factors associated with complications. METHODS A review of all patients with PEx treated with a Nuss procedure from 2003 to 2011 was performed. Complications included hemo/pneumothorax, infection, bar migration, and operative injury. Chi-square, Student's t-test, and logistic regression were performed. RESULTS The study included 127 Nuss patients with a the median age of 15.2 years (5.4-18.7) and a mean Haller index of 4.2 (+1.6). The total complication rate was 26% and bar migration rate was 18%. The use of a stabilizer was associated with fewer overall complications (17% vs 41%,p=0.006), decreased reoperation (16% vs 41%,p=0.003), decreased readmission (15% vs 39%,p=0.004), and decreased bar migration rate (9% vs 36%,p=0.001) compared to patients without a stabilizer. On multivariate analysis, the use of a stabilizer (OR 0.18,p=0.011,95% CI 0.049-0.68) and the use of a pericostal suture (OR 0.19,p=0.03,95% CI 0.41-0.85) were associated with decreased rates of bar migration. CONCLUSION The use of a lateral stabilizer and pericostal sutures decreased complication and reoperation rates for the Nuss procedure.
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Yoshida A, Uemura S, Yamamoto M, Nouso H, Kuyama H, Muta Y. Correlation of asymmetric chest wall deformity and growth in patients with pectus excavatum. J Pediatr Surg 2013; 48:771-5. [PMID: 23583132 DOI: 10.1016/j.jpedsurg.2012.11.036] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2012] [Revised: 11/05/2012] [Accepted: 11/09/2012] [Indexed: 11/18/2022]
Abstract
PURPOSE Pectus excavatum involves wide range of chest wall depression. The degree of depression or asymmetry varies between young and adolescent patients. It has not been clear how the deformity progresses as patients grow. To elucidate the change of asymmetric deformity, preoperative computed tomography (CT) scan was evaluated according to different age groups. METHODS Preoperative CT scans of 154 patients with pectus excavatum were collected and analyzed using Haller's CT index, asymmetric index and sternal rotation angle. Patients were divided into 5 age groups as follows; group 1: 4-6 y (n=53), group 2: 7-9 y (n=25), group 3: 10-12 y (n=25), group 4: 13-15 y (n=23), group 5: 16-23 y (n=28). The degree of asymmetric chest wall deformity was expressed using sternal rotation angle as follows; symmetrical (-5º to +5º), left-mild (-5º to -15º), right-mild (+5º to +15º), right-moderate (+15º to +25º) and right-severe (over +25º). RESULTS As the age of patients increased, asymmetric index increased from 1.025±0.065 in group 1 to 1.124±0.111 in group 5 and sternal rotation angle also increased from 6.11±8.61 in group 1 to 15.41±11.98 in group 5. In these two parameters, significant difference was seen between group 1 and 4, group 2 and 4, group 1 and 5 and group 2 and 5. However, average CT index revealed no significant difference in any age groups. In group 1, 83% of patients were classified in symmetrical or left- and right-mild. The incidence of right-moderate plus right-severe was 17% in group 1, 20% in group 2, 40% in group 3, 52.1% in group 4 and 50% in group 5. CONCLUSIONS The degree of chest depression did not show any change in all age groups. Asymmetric deformity on the right side progressed around the age of 10 to 12. Half of patients over the age of 13 showed moderate or severe asymmetry. These results were suggestive to consider the optimum age for the correction of pectus excavatum.
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Affiliation(s)
- Atsushi Yoshida
- Department of Pediatric Surgery, Kawasaki Medical School, 577 Matsushima, Kurashiki, Okayama, 701-0192, Japan.
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Umuroglu T, Bostancı K, Thomas DT, Yuksel M, Gogus FY. Perioperative anesthetic and surgical complications of the Nuss procedure. J Cardiothorac Vasc Anesth 2013; 27:436-40. [PMID: 23545345 DOI: 10.1053/j.jvca.2012.10.016] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2012] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The Nuss procedure is a chest wall remodeling surgery performed in patients with pectus excavatum. This study was performed to analyze perioperative surgical and anesthetic complications with the Nuss procedures. DESIGN A retrospective analysis. SETTING An academic hospital. PARTICIPANTS Two hundred fourteen patients (children, adolescents, and adults) undergoing the Nuss procedure over 6 years. INTERVENTIONS Patient age and sex, premorbid diseases, indications for surgery, patient position during the procedure, the length of surgery, time to hospital discharge, postoperative analgesia method, and the presence of perioperative complications were recorded. MEASUREMENTS No mortality was observed. The overall complication rate was 18.7%, but the overall event rate was 42.6% (91 events in 40 patients). Intraoperative hypotension, tachycardia, and hypercapnia were the most common complications (4.7%), followed by postoperative ileus (3.2%), pneumothorax (right, left, or bilateral; 4.2%), lung parenchymal laceration (2.3%), and postoperative nausea and vomiting (2.3%). Two patients had an ulnar nerve palsy and 1 patient had a brachial nerve palsy as a result of surgical position. CONCLUSION Although the Nuss procedure is reported to be minimally invasive, some serious complications concerning both surgery and anesthesia should not be overlooked.
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Affiliation(s)
- Tumay Umuroglu
- Department of Anesthesiology, Medical School of Marmara University, Istanbul, Turkey.
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Cho SH, Sung YM, Kim JH, Kim YK, Lee JI. Axillary artery to pulmonary artery fistula following Nuss procedure for pectus excavatum. Ann Thorac Cardiovasc Surg 2013; 20 Suppl:570-3. [PMID: 23518629 DOI: 10.5761/atcs.cr.12.02140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Systemic artery to pulmonary vessel fistula (SAPVF) is an uncommon condition, which is congenital or acquired. We recently encountered a patient with acquired axillary artery to pulmonary artery fistula detected by dual-source 64-slice computed tomography (DSCT) angiography who had a Nuss surgical procedure for pectus excavatum. He suffered from wound infection following bar removal. Conventional angiography also demonstrated the SAPVF and successful embolization for treatment was carried out using microcoils and polyvinyl alcohol particles. To our knowledge, there has been no report of an axillary artery to pulmonary artery fistula associated with wound infection following a Nuss procedure.
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Affiliation(s)
- So Hyun Cho
- Department of Radiology, Gil Hospital, Gachon University of Medicine and Science
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An uncommon complication of Nuss bar removal: Is blind removal a safe procedure? JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2013. [DOI: 10.1016/j.epsc.2013.02.014] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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220
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Zampieri N, Ruggeri G, Scirè G, Gargano T, Camoglio SF, Lima M. The role of transthoracic ultrasounds to assess patients with pectus excavatum. J Pediatr Surg 2013; 48:496-501. [PMID: 23480902 DOI: 10.1016/j.jpedsurg.2012.07.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 07/25/2012] [Accepted: 07/27/2012] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Pectus excavatum is the most common congenital malformation of the anterior chest wall. The purpose of this study is to assess the role of thoracic ultrasound studies in the preoperative workup of patients affected by pectus excavatum and to identify the dynamics of the chest wall. MATERIALS AND METHODS An observational study was carried out between January and September 2011. Patients between 4 and 14 years of age were divided into 5 study groups. Group A: healthy patients without pectus excavatum; Group B: healthy patients with different grades of untreated pectus excavatum; Group C: patients with pectus excavatum treated with a Nuss bar; Group D: patients surgically treated with removed bar; Group E: patients surgically treated with different techniques. RESULTS Patients with deeper anatomical depression showed a differential value between maximum inspiration and forced expiration lower than healthy patients or patients with shallower depression (p<0.05) in any age range considered. A depression deeper than 2.8 cm was associated with lower elasticity of the chest wall. CONCLUSIONS Study results demonstrate that the ultrasound is useful in patients with PE. Patients with pectus excavatum have altered chest dynamics when compared to healthy patients. The study also demonstrate that between the 4th and the 6th ribs there is the great dynamicity of the chest wall.
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Affiliation(s)
- Nicola Zampieri
- Department of Surgical Sciences, Pediatric Surgical Unit, University of Verona, Policlinico G.B.Rossi, Piazzale Scuro n. 1-Verona, Italy.
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Modified Nuss Procedure in Concurrent Repair of Pectus Excavatum and Open Heart Surgery. Ann Thorac Surg 2013; 95:1043-9. [DOI: 10.1016/j.athoracsur.2012.11.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 10/30/2012] [Accepted: 11/06/2012] [Indexed: 11/21/2022]
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Jayaramakrishnan K, Wotton R, Bradley A, Naidu B. Does repair of pectus excavatum improve cardiopulmonary function? Interact Cardiovasc Thorac Surg 2013; 16:865-70. [PMID: 23449664 DOI: 10.1093/icvts/ivt045] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
A best evidence topic was written according to a structured protocol. The question addressed was 'Does repair of pectus excavatum (PE) improve cardiopulmonary function?' One hundred and sixty-eight papers were found using the reported search, 19 level III evidence papers and three meta-analyses were relevant. Studies were divided into four groups based on the surgical technique applied and pulmonary and cardiac functions in these groups were analysed. The meta-analyses show conflicting results for improvements in pulmonary and cardiac functions when comparing surgical techniques, while four more recent studies show improved long-term results using the Nuss technique. The best evidence of papers studying the PE repair using the minimally invasive Nuss technique demonstrates a decrease in pulmonary function during the early postoperative period, however, there is a small but significant improvement during the late postoperative period and after bar removal. The best evidence for cardiac function in this group suggests an early improvement that is sustained during further follow-up. The best evidence of papers studying the PE repair using the Ravitch technique shows that pulmonary function decreased during the early postoperative period, however, there is a small but significant improvement during the late postoperative period. The best evidence for cardiac function in this group suggests an early improvement that is sustained during further follow-up. The best evidence of papers studying the PE repair using other techniques (modified Daniel's technique, modified Baronofsky's technique, sterno-costal turn-over technique and sterno-costal elevation technique) or where surgical techniques used were not described (preceding year 1985) suggests that there is no improvement in pulmonary function after surgery. There is some evidence that certain aspects of cardiac function improved after surgery in this group.
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Wessel L, Petersen C. Rekonstruktive Chirurgie der Thoraxwand. Monatsschr Kinderheilkd 2013. [DOI: 10.1007/s00112-012-2757-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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224
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Lakoma A, Kim ES. Current readings: surgical repair experience of congenital chest wall deformities. Semin Thorac Cardiovasc Surg 2013; 25:317-22. [PMID: 24673961 DOI: 10.1053/j.semtcvs.2013.12.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/20/2013] [Indexed: 11/11/2022]
Abstract
Major advancements have been made in the surgical repair of congential chest wall deformities. This review highlights selected readings of the experience in correction of pectus excavatum and pectus carinatum. In particular, it summarizes the current standard of care and outcomes of new and modified procedures for patients with chest wall deformities.
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Affiliation(s)
- Anna Lakoma
- Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Eugene S Kim
- Department of Surgery, Baylor College of Medicine, Houston, Texas..
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225
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Papandria D, Arlikar J, Sacco Casamassima MG, Ortega G, Salazar JH, Zhang Y, Lukish J, Colombani P, Abdullah F. Increasing age at time of pectus excavatum repair in children: emerging consensus? J Pediatr Surg 2013; 48:191-6. [PMID: 23331814 DOI: 10.1016/j.jpedsurg.2012.10.036] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2012] [Accepted: 10/13/2012] [Indexed: 10/27/2022]
Abstract
BACKGROUND Advances in surgical technique for pectus excavatum repair continue to change practice patterns. The present study examines trends in operative age in a nationwide administrative database. METHODS A cross-sectional descriptive analysis was performed using the Nationwide Inpatient Sample (NIS) and Kids' Inpatient Database (KID) data from 1998 to 2009. Pediatric discharges involving surgical repair of pectus excavatum were selected. Patients were sub-grouped by age at operation and calendar year of repair for further comparison. RESULTS A total of 5830 elective admissions were identified that met inclusion criteria. Mean age at operation was 13.5 years, and this increased from 11.8 years to 14.4 years over the period studied and was accompanied by narrowing of the interquartile range. Examined over groups of four calendar years, patient age at the time of repair was significantly higher in more recent years in both unadjusted and multivariate analyses (P < .001). CONCLUSIONS The age at operation in this sample has steadily increased, with an accompanying decrease in variability. This is consistent with previous findings and with overall trends in patient selection reported in the literature. This selection pattern may reflect evolving consensus regarding optimal management of pectus excavatum and provide clinical guidance regarding appropriate referral and intervention.
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Affiliation(s)
- Dominic Papandria
- Center for Pediatric Surgical Clinical Trials & Outcomes Research, Division of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21287-0005, USA
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Mazur L, de Ybarrondo L, Pickard L, Rao PS. Development of supravalvular pulmonary artery stenosis following a Nuss procedure. J Pediatr Surg 2012; 47:e61-4. [PMID: 23217921 DOI: 10.1016/j.jpedsurg.2012.09.049] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2012] [Revised: 09/26/2012] [Accepted: 09/28/2012] [Indexed: 11/15/2022]
Abstract
We report a case of a 13-year old girl with pectus excavatum who had a Nuss procedure and two years later a new cardiac murmur appeared which on investigation was diagnosed as supravalvular pulmonary artery stenosis. Following removal of the Nuss bar the stenosis resolved.
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Affiliation(s)
- Lynnette Mazur
- Shriners Hospital for Children, Houston, Texas 77030, USA.
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227
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Moon YE, Kim JE, Park HJ. Comparison of respiratory mechanics in adult patients undergoing minimally invasive repair of the pectus excavatum and removal of a pectus bar. J Cardiothorac Vasc Anesth 2012; 27:441-4. [PMID: 23140756 DOI: 10.1053/j.jvca.2012.09.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2012] [Indexed: 11/11/2022]
Abstract
OBJECTIVE The objective of this study was to compare the respiratory mechanics and gas exchange in adult patients undergoing minimally invasive repair of the pectus excavatum (MIRPE group) and removal of a pectus bar (bar removal group). DESIGN A prospective observational study. SETTING A tertiary university hospital. PARTICIPANTS Thirty-two patients scheduled for elective MIRPE or removal of a pectus bar. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Spirometry was used to measure the peak inspiratory airway pressure (PIP), static compliance, and respiratory resistance. The measurements were recorded at 1 minute after beginning mechanical ventilation (T0), 15 minutes after beginning sevoflurane inhalation (T1), and after the insertion (or removal) of a pectus bar through the chest wall (T2). Pulmonary gas exchange was assessed by calculating the alveolar arterial oxygen tension difference (AaDO2) before surgical incision and after insertion (or removal) of the pectus bar. In the MIRPE group, static compliance was decreased significantly (p < 0.001), and PIP was increased significantly (p < 0.001) after insertion of the pectus bar (T2) compared with baseline. In contrast, the bar removal group showed the opposite results. There were significant differences in static compliance and PIP at T2 between the groups (p = 0.002 and 0.026, respectively). AaDO2 was increased significantly in the MIRPE group compared with the bar removal group (p = 0.012). CONCLUSIONS Insertion of the pectus bar through the chest wall results in significant changes in respiratory mechanics and gas exchange. Therefore, close attention to pulmonary function is required during and after these surgical procedures.
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Affiliation(s)
- Young Eun Moon
- Department of Anesthesiology and Pain Medicine, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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228
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Wang Y, Chen G, Xie L, Tang J, Ben X, Zhang D, Xiao P, Zhou H, Zhou Z, Ye X. Mechanical factors play an important role in pectus excavatum with thoracic scoliosis. J Cardiothorac Surg 2012; 7:118. [PMID: 23140473 PMCID: PMC3514121 DOI: 10.1186/1749-8090-7-118] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Accepted: 11/03/2012] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND This study investigated the incidence, imaging characteristics and mechanical factors in scoliotic patients with pectus excavatum. METHODS A total of 142 scoliostic patients with pectus excavatum were evaluated prior to operation. The evaluation included a complete physical exam, phenotype and severity of the pectus excavatum, incidence and severity of scoliosis, and analysis of radiological images, including calculation of the Haller index. RESULTS Twenty five out of 142 patients (17.61%) with pectus excavatum had scoliosis with a Cobb angle >10 degrees, and in 80.00% of the cases the spinal column was bent to the right. Seventeen patients had bent-to-the-right spines that involved the 6th to 10 th thoracic vertebrae. We found that 23 out of 25 patients with a Cobb angle more than 10° were teenagers and adults. The incidence of scoliosis was only 6.06% in the children under 11 years whereas it was 21.79% in the teenage group. CONCLUSIONS Mechanical forces appear to play a role in the coexistence of pectus excavatum and scoliosis. There is a relationship between age, severity (Haller index), asymmetry and scoliosis. The heart and mediastinum play a role in providing an outward force to the left of the sternum which may be an important reason for the coexistence of pectus excavatum and scoliosis, but the correlation needs further proof.
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Affiliation(s)
- Yuncang Wang
- Department of Thoracic Surgery, The First Hospital of Hebei Medical University, Shijiazhuang 050031, China
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229
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Ricca RL, Kasten J, Javid PJ. Superior mesenteric artery syndrome after minimally invasive correction of pectus excavatum: impact of post-operative weight loss. J Pediatr Surg 2012; 47:2137-9. [PMID: 23164012 DOI: 10.1016/j.jpedsurg.2012.09.044] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 09/04/2012] [Accepted: 09/13/2012] [Indexed: 11/28/2022]
Abstract
We report the case of a 14-year-old boy with pectus excavatum and mild scoliosis. The patient underwent a minimally invasive Nuss repair with excellent cosmetic result. He returned 3 weeks post-operatively with bilious emesis and a 3.6-kg weight loss (5.5% of total body weight). Radiographic evaluation was consistent with the diagnosis of superior mesenteric artery syndrome and the child ultimately required nasojejunal feedings. Following return to his baseline weight, he was transitioned to oral feedings and has done well in follow-up. This is the first report of SMA syndrome following minimally invasive pectus excavatum repair.
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Affiliation(s)
- Robert L Ricca
- Division of Pediatric General and Thoracic Surgery, Seattle Children's Hospital and University of Washington, USA.
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230
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Liu T, Liu H, Yang C, Xu S, Sun C. Brachial plexus palsy, a rare delayed complication of the Nuss procedure for pectus excavatum: a case report. J Pediatr Surg 2012; 47:e19-20. [PMID: 23164024 DOI: 10.1016/j.jpedsurg.2012.07.045] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2012] [Revised: 07/18/2012] [Accepted: 07/18/2012] [Indexed: 11/30/2022]
Abstract
We report a rare complication after the Nuss procedure for the correction of pectus excavatum in a 15-year-old adolescent boy. He began to have delayed right brachial plexus injury on the 15th postoperative day. Careful physical check-up revealed a painful and enlarged subaxillary lymph node. He was successfully treated using anti-inflammatory medications and physical therapy.
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Affiliation(s)
- Tieqin Liu
- Department of Thoracic Surgery, First Affiliated Hospital, China Medical University, Shenyang 110001, Liaoning Province, People's Republic of China
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231
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Haecker FM, Sesia SB. Intraoperative Use of the Vacuum Bell for Elevating the Sternum During the Nuss Procedure. J Laparoendosc Adv Surg Tech A 2012; 22:934-6. [DOI: 10.1089/lap.2012.0030] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Frank-Martin Haecker
- Division of Pediatric Surgery, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Sergio Bruno Sesia
- Division of Pediatric Surgery, University Children's Hospital Basel, University of Basel, Basel, Switzerland
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232
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Kang CH, Park S, Park IK, Kim YT, Kim JH. Long-term Surveillance Comparing Satisfaction between the Early Experience of Nuss Procedure vs. Ravitch Procedure. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2012; 45:308-15. [PMID: 23130304 PMCID: PMC3487014 DOI: 10.5090/kjtcs.2012.45.5.308] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/28/2011] [Revised: 04/12/2012] [Accepted: 04/28/2012] [Indexed: 11/16/2022]
Abstract
Background Long-term surveillance comparing satisfaction between the early experience of Nuss procedure vs. Ravitch procedure. Materials and Methods A total of 100 patients that underwent surgical correction of a pectus excavatum between 2001 and 2004 and were followed for ≥2 years were included. Surveillance on the degree of satisfaction was performed using five-levels of the Likert scale and self-assessment scoring. Results Nuss or Ravitch surgery was performed in 63 and 37 patients, respectively. The Nuss procedure required a shorter operation time and shorter hospital stay than the Ravitch procedure (p<0.001). The surveillance demonstrated that 17.6% of the Nuss group and 35.7% of the Ravitch group were not satisfied with the outcome of the surgery (p=0.072). The most common causes of dissatisfaction were redepression in the Nuss group (n=5) and incomplete correction in the Ravitch group (n=7). The multivariate analysis showed that reoperation and a high postoperative pectus index were significant risk factors for a low satisfaction score. Conclusion The Nuss procedure had several advantages over the Ravitch procedure in the immediate postoperative period. However, the long-term satisfaction was determined by a complete correction without recurrence or need for re-intervention rather than by the operation type.
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Affiliation(s)
- Chang Hyun Kang
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Korea
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233
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Rokitansky AM, Stanek R. Modified minimally invasive pectus repair in children, adolescents and adults: an analysis of 262 patients. Eur Surg 2012. [DOI: 10.1007/s10353-012-0099-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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234
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Tanaka K, Kuwashima N, Ashizuka SI, Yoshizawa J, Ohki T. Risk factors of infection of implanted device after the Nuss procedure. Pediatr Surg Int 2012; 28:873-6. [PMID: 22864590 DOI: 10.1007/s00383-012-3145-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
PURPOSE The Nuss procedure is a minimally invasive procedure for the correction of pectus excavatum. It involves insertion of a substernal metal bar. A feared complication of any implantation procedure is infection, which often requires removal of the implanted device. This report describes the authors' experience with infectious complications after the Nuss procedure. METHODS The study included 195 patients diagnosed with pectus excavatum. We performed the Nuss procedure under thoracoscopic control on all the patients. Factors analyzed for all patients included bar infection, sex, age, number of bars, and season of the year during which the operation was performed. RESULTS Of the 195 study patients, there were 11 patients who suffered postoperative infectious complications, including 7 patients with cellulitis and 4 patients with bar infections. We removed the infected bars from three of the patients with bar infections. Ten of the patients with infected bar had undergone their operations in the summer. Sex, age and number of bars did not differ significantly between patients with or without infections. However, a significantly higher number of infections occurred among patients who underwent the Nuss procedure in the summer compared with the other seasons of the year (P < 0.05, Kruskal-Wallis Test). CONCLUSION All patients with cellulitis successfully recovered with conservative treatment. However, 75 % of the patients with bar infections required removal of the infected device. Our study results showed that performance of the Nuss procedure during summer is a risk factor for postoperative infection. We recommend that particularly careful technique must be used during summer to prevent postoperative infections following the Nuss procedure.
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Affiliation(s)
- Keiichiro Tanaka
- Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-Shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
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235
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Puma F, Vannucci J, Santoprete S. External longitudinal titanium support for the repair of complex pectus excavatum in adults. Eur J Cardiothorac Surg 2012; 42:e166-8. [PMID: 22927563 DOI: 10.1093/ejcts/ezs485] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Several techniques exist for the repair of complex pectus excavatum. The placement of retrosternal metal bars improves the results by reducing the recurrence rate, but entails several possible risks, complications and disadvantages. A new method, specifically conceived for the repair of severe, asymmetric forms in adult patients, is reported. The corrected bone is fixed in the proper position by two, patient-customized, titanium struts, externally screwed to the manubrium and sternal body. Any retrosternal bar is thus avoided, reducing possible complications, without hampering the chest wall dynamic. In this particularly difficult issue, this technique provides long-term good functional, mechanical and cosmetic results and does not entail a second surgery for struts removal.
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Affiliation(s)
- Francesco Puma
- Thoracic Surgery Unit, University of Perugia Medical School, Ospedale S. Maria della Misericordia, Perugia, Italy.
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236
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Dimitrakakis G, von Oppell UO, Miller C, Kornaszewska M. Simultaneous mitral valve and pectus excavatum repair with a Nuss bar. Eur J Cardiothorac Surg 2012; 42:e86-8. [DOI: 10.1093/ejcts/ezs392] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Serum metal levels after minimally invasive repair of pectus excavatum. J Pediatr Surg 2012; 47:1506-11. [PMID: 22901908 DOI: 10.1016/j.jpedsurg.2012.02.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2011] [Revised: 01/06/2012] [Accepted: 02/08/2012] [Indexed: 11/22/2022]
Abstract
BACKGROUND Metal implants may wear and corrode, resulting in systemic dissemination of metallic debris that is measurable in serum. Concern exists regarding adverse health effects related to implant-derived debris. Minimally invasive repair of pectus excavatum (MIRPE) is a popular technique in which a stainless steel substernal bar is implanted to achieve deformity correction. Serum metal levels have not previously been investigated after MIRPE. METHODS Serum chromium, molybdenum, and nickel levels were measured in this cross-sectional study of 11 children implanted with pectus bars after MIRPE. Samples were analyzed using high-resolution inductively coupled plasma mass spectrometry. RESULTS Median serum chromium and nickel values were elevated 3.3-fold (P = .0003) and 2.3-fold (P = .25), respectively, compared with age-matched controls. Serum chromium and nickel levels were abnormally elevated in 6 (55%) of 11 and 5 (45%) of 11, respectively. In patients whom postexplantation metal levels were measured, previously elevated levels were lowered. Serum chromium levels in children after MIRPE are comparable with adult cohorts with hip arthroplasty implants measured 1-year postoperatively. No acute metal toxicity was observed. CONCLUSIONS Abnormally elevated levels of serum metal levels are measurable in children implanted with pectus bars. These findings warrant further investigation to assess the biocompatibility of this surgical implant in children.
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Dimitrakakis G, von Oppell UO. eComment. Pectus excavatum: the surgical opinion. Interact Cardiovasc Thorac Surg 2012; 14:806. [PMID: 22589348 DOI: 10.1093/icvts/ivs186] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Swanson JW, Avansino JR, Phillips GS, Yung D, Whitlock KB, Redding GJ, Sawin RS. Correlating Haller Index and cardiopulmonary disease in pectus excavatum. Am J Surg 2012; 203:660-664. [DOI: 10.1016/j.amjsurg.2011.12.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2011] [Revised: 12/14/2011] [Accepted: 12/14/2011] [Indexed: 11/29/2022]
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Kye YK, Kim YD. Intercostal lung hernia after pectus bar removal. THE KOREAN JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY 2012; 45:138-9. [PMID: 22500288 PMCID: PMC3322187 DOI: 10.5090/kjtcs.2012.45.2.138] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 09/22/2011] [Accepted: 10/18/2011] [Indexed: 11/25/2022]
Affiliation(s)
- Yeo Kon Kye
- Department of Thoracic and Cardiovascular Surgery, Bucheon St. Mary's Hospital, The Catholic University of Korea School of Medicine, Korea
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243
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Lin CW, Chen KC, Diau GY, Chu CC. Late-onset vital complication after the Nuss procedure for pectus excavatum. Pediatr Surg Int 2012; 28:71-3. [PMID: 21656170 DOI: 10.1007/s00383-011-2936-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/23/2011] [Indexed: 11/25/2022]
Abstract
The Nuss procedure is the most popular technique for correction of pectus excavatum recently. Life-threatening complications associated with the procedure are very rare. We report a 13-year-old boy who developed late-onset bilateral hemothorax with hypovolemic shock 5 months after the Nuss procedure. In literature review, this is the first case of the late-onset life-threatening bilateral hemothorax with hypovolemic shock ever reported.
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Affiliation(s)
- Chieh-Wen Lin
- Division of Pediatric Surgery, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
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Kurosawa TA, Ruth JD, Steurer J, Austin B, Heng HG. Imaging diagnosis--acquired pectus excavatum secondary to laryngeal paralysis in a dog. Vet Radiol Ultrasound 2011; 53:329-32. [PMID: 22145690 DOI: 10.1111/j.1740-8261.2011.01898.x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2011] [Accepted: 10/31/2011] [Indexed: 11/29/2022] Open
Abstract
A 13-year-old neutered female Labrador retriever had inspiratory dyspnea secondary to bilateral laryngeal paralysis. Radiographically, there was pectus excavatum with a mediastinal shift to the right. Arytenoid lateralization was performed, relieving the upper respiratory obstruction, and the sternal deformity also resolved. Chronic upper respiratory obstruction should be considered in dogs with pectus excavatum. Furthermore, correction of upper respiratory obstruction has the potential to result in resolution of pectus excavatum.
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Affiliation(s)
- Tsumugi Anne Kurosawa
- Department of Veterinary Clinical Sciences, Purdue University School of Veterinary Medicine, West Lafayette, IN 47907, USA
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Kim HK, Shim JH, Choi KS, Choi YH. The quality of life after bar removal in patients after the nuss procedure for pectus excavatum. World J Surg 2011; 35:1656-61. [PMID: 21560000 DOI: 10.1007/s00268-011-1111-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND The goal of this study was to evaluate the outcome of patients who had the Nuss procedure for repair of pectus excavatum. METHODS Thirty-nine patients (26 male, 13 female) of 61 (63.9%) who had bar removal after the Nuss procedure agreed to participate in an interview. All patients and their parents were asked to complete a questionnaire. RESULTS The mean age of the patients was 6.8±3.23 years at the time of the Nuss procedure, 9.1±3.54 at bar removal, and 12.0±3.28 when the questionnaire was completed. The scores for satisfaction with the procedure, sense of social belonging, and well-being increased after the Nuss procedure according to the responses of the patients and their parents. However, the scores did not significantly differ after bar removal compared to after the Nuss procedure. Patients (4.1±1.08) and parents (4.1±1.02) reported that they were satisfied with the final result and their responses did not significantly differ (P=0.498). However, the surgical team's score for overall satisfaction was 4.5, which was higher than the patients' and/or parents' scores (P=0.019). CONCLUSION The Nuss procedure had a positive impact on the patients' and parents' quality of life. However, the scores before and after bar removal did not differ.
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Affiliation(s)
- Hyun Koo Kim
- Department of Thoracic and Cardiovascular Surgery, Korea University Guro Hospital, Korea University College of Medicine, Guro-dong, Guro-gu, Seoul, 152-703, Korea
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Abstract
PURPOSE OF REVIEW The introduction of the Nuss procedure in 1997 for treatment of pectus excavatum, in conjunction with the ever-expanding body of medical information available on the internet, significantly raised the level of awareness for this deformity as both an anatomic and a functional problem. The subsequent increase in referrals for pectus excavatum repair provided large patient series for clinical analyses to better define underlying physiologic impairments and stimulated surgeons to develop technical improvements to enhance the safety and effectiveness of pectus excavatum repair. RECENT FINDINGS Clinical assessment, diagnostic imaging, and cardiorespiratory testing of patients with pectus excavatum have helped to characterize physiologic impairments associated with severe pectus excavatum and to define inclusion criteria for surgical repair. Appropriate timing of repair is important to minimize complications, especially recurrence. Evidence of improved cardiorespiratory function after pectus excavatum repair has been presented. As a result of numerous technical improvements, safe and effective operative correction of pectus excavatum has been reported for both the Nuss procedure and open repair. SUMMARY The findings presented in this review provide objective evidence of the cardiorespiratory impairment associated with severe pectus excavatum. Clinical identification of affected patients should prompt timely work-up and referral for pectus excavatum repair if inclusion criteria are met. Regular follow-up through pubertal growth is recommended.
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Shu Q, Shi Z, Xu WZ, Li JH, Zhang ZW, Lin R, Zhu XK, Yu JG. Experience in minimally invasive Nuss operation for 406 children with pectus excavatum. World J Pediatr 2011; 7:257-61. [PMID: 21822992 DOI: 10.1007/s12519-011-0319-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Accepted: 06/10/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND This study was to investigate the advantages of thoracoscopy-assisted minimally invasive Nuss operation for the treatment of pectus excavatum (PE) in children. METHODS A total of 406 patients with PE (female: 93; male: 313) with an average age of 6.8 years (range: 3.5-17.5 years) were included in this study. Associated diseases included congenital heart disease in 9 patients and congenital pulmonary cyst in 2. The Haller index of the patients ranged from 3.35 to 7.23, with an average of 5.17±1.64. Minimally invasive Nuss operation was performed for all the patients. RESULTS The operations were performed successfully and no operative mortality occurred. The average blood loss during the operation was less than 10 mL and the operating time ranged from 30 to 85 minutes with an average of 45 minutes. The length of hospital stay ranged from 5 to 9 days with an average of 7 days. Struts were implanted in 12 (3.0%) of the 406 patients. Injury of the pericardium occurred in 1 patient during the operation. Early post-operative complications occurred in 9 patients with pneumothorax and 6 patients with pleural effusion, which were cured by puncture or drainage. Poor wound healing occurred in 4 patients (1.0%) and was cured by nutritional support. During a 3-month to 6-year follow-up, 2 patients had scoliosis and 3 patients had displacement of the strut, which was cured by a second Nuss operation. Allergy occurred in 2 patients: the symptoms were improved in 1 patient after conservative treatment, but the strut was removed in advance due to allergy in the other patient. Totally 154 patients (40.0%) underwent operation for strut removal. Excellent repair results were achieved in 387 (95.3%) patients, good repair results in 12 (3.0%), and fair results in 7 (1.7%). CONCLUSIONS Thoracoscopy-assisted Nuss operation has many advantages including small and masked incision, short operative time, minimal blood loss, fast recovery, less trauma, and satisfactory outcomes of repair. Nuss is a safe and reliable technique for repair of PE.
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Affiliation(s)
- Qiang Shu
- Department of Cardiothoracic Surgery, Children's Hospital, Zhejiang University School of Medicine, and Zhejiang Key Laboratory for Diagnosis and Treatment of Neonatal Diseases, Hangzhou, 310003, China
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Patient satisfaction and clinical results 10 years after modified open thoracoplasty for pectus deformities. Langenbecks Arch Surg 2011; 396:1213-20. [PMID: 21779828 DOI: 10.1007/s00423-011-0827-2] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2010] [Accepted: 07/04/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE Indications for surgical treatment for patients with pectus excavatum and carinatum are psychosocial issues, pulmonary or cardiac limitations or pain. When surgery is indicated in our institution, patients are treated with a modified thoracoplasty according to the Ravitch technique. In order to stabilize pectus excavatum, an allogenic bone strut is transplanted which does not require removal. PATIENT AND METHODS Seventy-one patients with a mean age of 17 years who were treated for pectus deformities between 1997 and 2007 were evaluated retrospectively. RESULTS The average period of follow-up was 5.3 years. Sixty-six percent of the patients suffered from pectus excavatum, 34% from pectus carinatum. One osseous revision had to be performed after overcorrection of pectus carinatum into pectus excavatum. Six minor complications occurred. At follow-up, the mean patient satisfaction score was 4.3 (scale 1-5). The Manchester Scar Scale resulted in 96% cosmetically well-healed scars. Clinically, 93% of the surgical results were rated good. CONCLUSIONS This study retrospectively shows that this modification of the Ravitch approach is a safe and effective treatment option for pectus deformities with long-term satisfactory results for the patients without the need for bar removal.
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