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Gonzalez GC, Berazaluce AMC, Jenkins TM, Hardie WD, Foster KE, Moore RA, Powell AW, Garcia VF, Brown RL. (F)utility of preoperative pulmonary function testing in pectus excavatum to assess severity. Pediatr Surg Int 2024; 40:102. [PMID: 38589706 PMCID: PMC11001679 DOI: 10.1007/s00383-024-05675-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/14/2024] [Indexed: 04/10/2024]
Abstract
PURPOSE The utility of pulmonary function testing (PFT) in pectus excavatum (PE) has been subject to debate. Although some evidence shows improvement from preoperative to postoperative values, the clinical significance is uncertain. A high failure-to-completion rate for operative PFT (48%) was identified in our large institutional cohort. With such a high non-completion rate, we questioned the overall utility of PFT in the preoperative assessment of PE and sought to evaluate if other measures of PE severity or cardiopulmonary function could explain this finding. METHODS Demographics, clinical findings, and results from cardiac MRI, PFT (spirometry and plethysmography), and cardiopulmonary exercise tests (CPET) were reviewed in 270 patients with PE evaluated preoperatively between 2015 and 2018. Regression modeling was used to measure associations between PFT completion and cardiopulmonary function. RESULTS There were no differences in demographics, symptoms, connective tissue disorders, or multiple indices of pectus severity and cardiac deformation in PFT completers versus non-completers. While regression analysis revealed higher RVEF, LVEF, and LVEF-Z scores, lower RV-ESV/BSA, LV-ESV/BSA, and LV-ESV/BSA-Z scores, and abnormal breathing reserve in PFT completers vs. non-completers, these findings were not consistent across continuous and binary analyses. CONCLUSIONS We found that PFT completers were not significantly different from non-completers in most structural and functional measures of pectus deformity and cardiopulmonary function. Inability to complete PFT is not an indicator of pectus severity.
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Affiliation(s)
- Gabriel C Gonzalez
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA.
- Department of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, Ohio, USA.
| | - Alejandra M Casar Berazaluce
- Division of Pediatric Surgery, Hasbro Children's Hospital, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA
- Department of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, Ohio, USA
| | - Todd M Jenkins
- Department of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, Ohio, USA
| | - William D Hardie
- Department of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Karla E Foster
- Department of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Ryan A Moore
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
- Cincinnati Children's Hospital Medical Center Heart Institute, Cincinnati, Ohio, USA
| | - Adam W Powell
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
- Cincinnati Children's Hospital Medical Center Heart Institute, Cincinnati, Ohio, USA
| | - Victor F Garcia
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
- Department of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, Ohio, USA
| | - Rebeccah L Brown
- College of Medicine, University of Cincinnati, Cincinnati, Ohio, USA
- Department of Pediatric Surgery, Cincinnati Children's Hospital Medical Center, 3333 Burnet Avenue, Cincinnati, Ohio, USA
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Abu-Tair T, Turial S, Willershausen I, Alkassar M, Staatz G, Kampmann C. Evaluating Cardiac Lateralization by MRI to Simplify Estimation of Cardiopulmonary Impairment in Pectus Excavatum. Diagnostics (Basel) 2023; 13:diagnostics13050844. [PMID: 36899988 PMCID: PMC10001214 DOI: 10.3390/diagnostics13050844] [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: 11/29/2022] [Revised: 02/01/2023] [Accepted: 02/17/2023] [Indexed: 02/25/2023] Open
Abstract
BACKGROUND The severity of pectus excavatum is classified by the Haller Index (HI) and/or Correction Index (CI). These indices measure only the depth of the defect and, therefore, impede a precise estimation of the actual cardiopulmonary impairment. We aimed to evaluate the MRI-derived cardiac lateralization to improve the estimation of cardiopulmonary impairment in Pectus excavatum in connection with the Haller and Correction Indices. METHODS This retrospective cohort study included a total of 113 patients (mean age = 19.03 ± 7.8) with pectus excavatum, whose diagnosis was verified on cross-sectional MRI images using the HI and CI. For the development of an improved HI and CI index, the patients underwent cardiopulmonary exercise testing to assess the influence of the right ventricle's position on cardiopulmonary impairment. The indexed lateral position of the pulmonary valve was utilized as a surrogate parameter for right ventricle localization. RESULTS In patients with PE, the heart's lateralization significantly correlated with the severity of pectus excavatum (p ≤ 0.001). When modifying HI and CI for the individual's pulmonary valve position, those indices are present with greater sensitivity and specificity regarding the maximum oxygen-pulse as a pathophysiological correlate of reduced cardiac function (χ2 10.986 and 15.862, respectively). CONCLUSION The indexed lateral deviation of the pulmonary valve seems to be a valuable cofactor for HI and CI, allowing for an improved description of cardiopulmonary impairment in PE patients.
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Affiliation(s)
- Tariq Abu-Tair
- Department of Congenital Heart Disease, Centre for Diseases in Childhood and Adolescence, University Medicine Mainz, 55131 Mainz, Germany
- Department of Pediatric Cardiology, Friedrich-Alexander-University Erlangen-Nürnberg, 91054 Erlangen, Germany
- Correspondence: ; Tel.: +49-9131-8541190; Fax: +49-9131-8535987
| | - Salmai Turial
- Department of General, Visceral, Vascular and Transplantation Surgery, Division of Pediatric Surgery, Pediatric Trauma Surgery and Pediatric Urology, University Medical Centre Magdeburg, 39120 Magdeburg, Germany
| | - Ines Willershausen
- Department of Orthodontics and Orofacial Orthopedics, Friedrich-Alexander University Erlangen-Nürnberg, 91054 Erlangen, Germany
| | - Muhannad Alkassar
- Department of Congenital Heart Disease, Centre for Diseases in Childhood and Adolescence, University Medicine Mainz, 55131 Mainz, Germany
| | - Gundula Staatz
- Department of Diagnostic and Interventional Radiology, Section of Pediatric Radiology, University Medicine Mainz, 55131 Mainz, Germany
| | - Christoph Kampmann
- Department of Congenital Heart Disease, Centre for Diseases in Childhood and Adolescence, University Medicine Mainz, 55131 Mainz, Germany
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Stephens EH, Dearani JA, Jaroszewski DE. Pectus Excavatum in Cardiac Surgery Patients. Ann Thorac Surg 2023; 115:1312-1321. [PMID: 36781097 DOI: 10.1016/j.athoracsur.2023.01.040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Revised: 12/23/2022] [Accepted: 01/09/2023] [Indexed: 02/13/2023]
Abstract
BACKGROUND Pectus excavatum frequently accompanies congenital heart disease and connective tissue diseases requiring cardiac surgery. Sometimes the indication is cardiac repair, with the pectus being incidentally noticed; other times, the pectus subsequently develops or becomes more significant after cardiac surgery. This review arms cardiac and congenital surgeons with background about the physiologic impact of pectus, indications for repair and repair strategies, and outcomes for cardiac surgery patients requiring pectus repair. METHODS A comprehensive literature review was performed using keywords related to pectus excavatum, pectus repair, and cardiac/congenital heart surgery within the PubMed database. RESULTS The risks of complications related to pectus repair, including in the setting of cardiac surgery or after cardiac surgery, are low in experienced hands, and patients demonstrate cardiopulmonary benefits and symptom relief. Concomitant pectus and cardiac surgery should be considered if it is performed in conjunction with those experienced in pectus repair, particularly given the increased cardiopulmonary impact of pectus after bypass. In the setting of potential bleeding or hemodynamic instability, delayed sternal closure is recommended. For those with anticipated pectus repair after cardiac surgery, the pericardium should be reconstructed for cardiac protection. For those undergoing pectus repair after cardiac surgery without a membrane placed, a "hybrid" approach is safe and effective. CONCLUSIONS Patients undergoing cardiac surgery noted to have pectus should be considered for possible concomitant or staged pectus repair. For those who will undergo a staged procedure, a barrier membrane should be placed before chest closure.
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Affiliation(s)
| | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Dawn E Jaroszewski
- Division of Thoracic Surgery, Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, Arizona.
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Ou H, Zheng Y, Li M, Liang J, Chen H, Lang S, Li Q, Chen D, Lin Y, Chen Q, Sun Y, Zheng M, You T, Lin Q. The impacts of surgical mask in young healthy subjects on cardiopulmonary function and muscle performance: a randomized crossover trial. Arch Public Health 2022; 80:138. [PMID: 35581631 PMCID: PMC9112472 DOI: 10.1186/s13690-022-00893-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/02/2022] [Indexed: 02/05/2023] Open
Abstract
Objective To explore the impacts of surgical mask in normal subjects on cardiopulmonary function and muscle performance under different motor load and gender differences. Design Randomized crossover trial. Setting The Fifth Affiliated Hospital of Guangzhou Medical University, June 16th to December 30th, 2020. Participants Thirty-one college students (age: male 21.27 ± 1.22 years; female 21.31 ± 0.79 years) were recruited and randomly allocated in two groups. Interventions Group 1 first received CPET in the mask-on condition followed by 48 h of washout, and then received CPET in the mask-off condition. Group 2 first received CPET in the mask-off condition followed by 48 h of washout, then received CPET in the mask-on condition. The sEMG data were simultaneously collected. Main outcome measures The primary outcome was maximum oxygen uptake (VO2 max) from CPET, which was performed on a cycle ergometer—this is the most important parameter associated with an individual’s physical conditioning. The secondary parameters included parameters reflecting exercise tolerance and heart function (oxygen uptake, anaerobic valve, maximum oxygen pulse, heart rate reserve), parameters reflecting ventilation function (respiration reserve, ventilation volume, tidal volume, breathing frequency), parameters reflecting gas exchange (end-tidal oxygen and carbon dioxide partial pressure, oxygen equivalent, carbon dioxide equivalent, and the relationship between dead space and tidal volume) and parameters reflecting skeletal muscle function [oxygen uptake, anaerobic valve, work efficiency, and EMG parameters including root mean square (RMS)]. Results Comparing the mask-on and mask-off condition, wearing surgical mask had some negative effects on VO2/kg (peak) and ventilation (peak) in both male and female health subjects [VO2/kg (peak): 28.65 ± 3.53 vs 33.22 ± 4.31 (P = 0.001) and 22.54 ± 3.87 vs 26.61 ± 4.03 (P < 0.001) ml/min/kg in male and female respectively; ventilation (peak): 71.59 ± 16.83 vs 82.02 ± 17.01 (P = 0.015) and 42.46 ± 10.09 vs 53.95 ± 10.33 (P < 0.001) liter in male and female respectively], although, based on self-rated scales, there was no difference in subjective feelings when comparing the mask-off and mask-on condition. Wearing surgical masks showed greater lower limb muscle activity just in male subjects [mean RMS of vastus medialis (load): 65.36 ± 15.15 vs 76.46 ± 19.04 μV, P = 0.031]. Moreover, wearing surgical masks produced a greater decrease in △tidal volume (VTpeak) during intensive exercises phase in male subjects than in female [male − 0.80 ± 0.15 vs female − 0.62 ± 0.11 l P = 0.001]. Conclusions Wearing medical/surgical mask showed a negative impact on the ventilation function in young healthy subjects during CPET, especially in high-intensity phase. Moreover, some negative effects were found both in ventilation and lower limb muscle actives in male young subjects during mask-on condition. Future studies should focus on the subjects with cardiopulmonary diseases to explore the effect of wearing mask. Trial registration Chinese Clinical Trial Registry (ChiCTR2000033449).
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Affiliation(s)
- Haining Ou
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, No. 621, Gangwan Road, Huangpu District, Guangzhou, 510700, China.,The Rehabilitation Medicine Lab, The Fifth Clinical College of Guangzhou Medical University, Guangzhou, 510700, China.,Guangzhou Key Laboratory of Enhanced Recovery after Abdominal Surgery, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510700, China.,Department of Rehabilitation Therapy, Guangzhou Medical University, Guangzhou, 511436, China
| | - Yuxin Zheng
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, No. 621, Gangwan Road, Huangpu District, Guangzhou, 510700, China.,The Rehabilitation Medicine Lab, The Fifth Clinical College of Guangzhou Medical University, Guangzhou, 510700, China.,Department of Rehabilitation Therapy, Guangzhou Medical University, Guangzhou, 511436, China
| | - Mei Li
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, No. 621, Gangwan Road, Huangpu District, Guangzhou, 510700, China.,The Rehabilitation Medicine Lab, The Fifth Clinical College of Guangzhou Medical University, Guangzhou, 510700, China
| | - Junjie Liang
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, No. 621, Gangwan Road, Huangpu District, Guangzhou, 510700, China.,The Rehabilitation Medicine Lab, The Fifth Clinical College of Guangzhou Medical University, Guangzhou, 510700, China.,Department of Rehabilitation Therapy, Guangzhou Medical University, Guangzhou, 511436, China
| | - Hongxin Chen
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, No. 621, Gangwan Road, Huangpu District, Guangzhou, 510700, China.,The Rehabilitation Medicine Lab, The Fifth Clinical College of Guangzhou Medical University, Guangzhou, 510700, China.,Department of Rehabilitation Therapy, Guangzhou Medical University, Guangzhou, 511436, China
| | - Shijuan Lang
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, No. 621, Gangwan Road, Huangpu District, Guangzhou, 510700, China.,The Rehabilitation Medicine Lab, The Fifth Clinical College of Guangzhou Medical University, Guangzhou, 510700, China.,Department of Rehabilitation Therapy, Guangzhou Medical University, Guangzhou, 511436, China
| | - Qinyi Li
- Department of Rehabilitation Therapy, Guangzhou Medical University, Guangzhou, 511436, China
| | - Delong Chen
- Department of Rehabilitation Therapy, Guangzhou Medical University, Guangzhou, 511436, China
| | - Youwei Lin
- Department of Rehabilitation Therapy, Guangzhou Medical University, Guangzhou, 511436, China
| | - Qiuxia Chen
- Department of Geriatrics, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510700, China
| | - Yue Sun
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, No. 621, Gangwan Road, Huangpu District, Guangzhou, 510700, China.,The Rehabilitation Medicine Lab, The Fifth Clinical College of Guangzhou Medical University, Guangzhou, 510700, China.,Department of Rehabilitation Therapy, Guangzhou Medical University, Guangzhou, 511436, China
| | - Meifeng Zheng
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, No. 621, Gangwan Road, Huangpu District, Guangzhou, 510700, China.,The Rehabilitation Medicine Lab, The Fifth Clinical College of Guangzhou Medical University, Guangzhou, 510700, China.,Department of Rehabilitation Therapy, Guangzhou Medical University, Guangzhou, 511436, China
| | - Tingting You
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, No. 621, Gangwan Road, Huangpu District, Guangzhou, 510700, China.,The Rehabilitation Medicine Lab, The Fifth Clinical College of Guangzhou Medical University, Guangzhou, 510700, China.,Department of Rehabilitation Therapy, Guangzhou Medical University, Guangzhou, 511436, China
| | - Qiang Lin
- Department of Rehabilitation Medicine, The Fifth Affiliated Hospital of Guangzhou Medical University, No. 621, Gangwan Road, Huangpu District, Guangzhou, 510700, China. .,The Rehabilitation Medicine Lab, The Fifth Clinical College of Guangzhou Medical University, Guangzhou, 510700, China. .,Guangzhou Key Laboratory of Enhanced Recovery after Abdominal Surgery, The Fifth Affiliated Hospital of Guangzhou Medical University, Guangzhou, 510700, China. .,Department of Rehabilitation Therapy, Guangzhou Medical University, Guangzhou, 511436, China.
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Ravanbakhsh S, Farina JM, Bostoros P, Abdelrazek A, Mi L, Lim E, Mead-Harvey C, Arsanjani R, Peterson M, Gotimukul A, Lackey JJ, Jaroszewski DE. Gender differences in objective measures of adult patients presenting for pectus excavatum repair. Ann Thorac Surg 2021; 114:1159-1167. [PMID: 34600903 DOI: 10.1016/j.athoracsur.2021.08.060] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 08/02/2021] [Accepted: 08/30/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND Women have a reported incidence of pectus deformities 4-5 times less than men. Gender differences have not been well studied. METHODS A retrospective review was performed of adult patients (≥18 years) who underwent a pectus excavatum repair at Mayo Clinic in Arizona (January 1, 2010-December 31, 2019). RESULTS In total, 776 adults underwent pectus repair with 30% being women. Women presented older (mean age 35 vs 32 years, p=0.007) and more symptomatic. Despite this, women performed better on cardiopulmonary exercise testing (higher VO2 max and O2 pulse). Women had more severe deformities (Haller index 5.9 vs 4.3, p<0.001). However, in 609 patients undergoing attempted primary minimally invasive pectus repair, intraoperative fractures/osteotomies occurred equally between genders with the majority occurring in patients ≥30 years of age (11.5% in ≥30, 1.7% in <30, total 7%). Women were also less likely to require 3 bars for repair (12% vs 42%, p<0.001). Hospital length of stay and postoperative complication rates were not significantly different. Postoperatively women reported a greater daily intensity of pain, but only on the initial postoperative day used significantly more opioids than men. Cardiopulmonary exercise testing in 142 patients undergoing baseline and postoperative evaluation at bar removal showed equal and significant benefits in both genders. CONCLUSIONS Women presented for pectus excavatum repair older and with greater symptoms and severity. Despite this, women required fewer bars, with no significant differences in length of stay or complications. Cardiopulmonary benefits of repair were significant and equal for both genders.
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Affiliation(s)
| | | | - Peter Bostoros
- Department of Cardiothoracic Surgery, Mayo Clinic Arizona
| | | | - Lanyu Mi
- Department of Cardiothoracic Surgery, Mayo Clinic Arizona
| | - Elisabeth Lim
- Department of Cardiothoracic Surgery, Mayo Clinic Arizona
| | | | - Reza Arsanjani
- Department of Cardiothoracic Surgery, Mayo Clinic Arizona
| | | | | | - Jesse J Lackey
- Department of Cardiothoracic Surgery, Mayo Clinic Arizona
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