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Masai K, Nakai T, Okubo Y, Kaseda K, Hishida T, Asakura K. Nuss procedure for the treatment of pectus excavatum with dyspnea following oropharyngeal cancer surgery: a case report. J Surg Case Rep 2024; 2024:rjad714. [PMID: 38250131 PMCID: PMC10799248 DOI: 10.1093/jscr/rjad714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2023] [Accepted: 12/11/2023] [Indexed: 01/23/2024] Open
Abstract
Pectus excavatum (PE) causes cardiopulmonary dysfunction depending on the degree and form of the depression. The patient was a 74-year-old woman with a history of PE. Fourteen years ago, a total glossolaryngectomy was performed for oropharyngeal cancer. Two years later, the patient gradually experienced difficulty in breathing. Computed tomography (CT) revealed severe PE and right main bronchial stenosis. We performed a Nuss procedure for PE repair to surgically release the stenosis of the right main bronchus. Postoperative chest CT showed improvement in the sternal depression and right main bronchial stenosis. Furthermore, shortness of breath was relieved postoperatively. Oropharyngeal cancer surgery may cause tracheal support disruption, leading to leftward shift and severe stenosis of the right main bronchus due to sternum depression. This is an important report regarding respiratory distress caused by a combination of PE and post-oropharyngeal cancer surgery.
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Affiliation(s)
- Kyohei Masai
- Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Taketo Nakai
- Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Yu Okubo
- Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Kaoru Kaseda
- Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Tomoyuki Hishida
- Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
| | - Keisuke Asakura
- Division of Thoracic Surgery, Department of Surgery, Keio University School of Medicine, Tokyo 160-8582, Japan
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Adachi R, Nishihara T, Morino T, Sekiya K, Kitamura S, Konishi A, Takasaki Y, Miura H, Abe N, Yorozuya T. Hemodynamic deterioration due to increased anterior and posterior cardiac compression during posterior spinal fusion for scoliosis with pectus excavatum. SAGE Open Med Case Rep 2022; 10:2050313X221090848. [PMID: 35573103 PMCID: PMC9096201 DOI: 10.1177/2050313x221090848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Accepted: 03/11/2022] [Indexed: 11/17/2022] Open
Abstract
Hemodynamics may deteriorate during the perioperative period when performing posterior spinal fusion in patients with pectus excavatum and scoliosis. A 13-year-old teenager diagnosed with Marfan syndrome had thoracic scoliosis and pectus excavatum. Thoracic scoliosis was convex to the right, and a right ventricular inflow tract stenosis was observed due to compression induced by the depressed sternum. The patient underwent T3–L4 posterior spinal fusion surgery for scoliosis. Deterioration of hemodynamics was observed when the patient was placed in the prone position or when the thoracic spine was corrected to the left front. Postoperative computed tomography examination showed that the mediastinal space was narrowed due to the corrected thoracic spine. Special attention should be paid in the following cases: (1) severe pectus excavatum, (2) right ventricular inflow tract compression due to depressed sternum on the left side, (3) correction of the thoracic spine on the left front, (4) long-term surgery, and (5) risk of massive bleeding. In some cases, pectus excavatum surgery should be prioritized.
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Affiliation(s)
- Ryota Adachi
- Department of Anesthesia and Perioperative Medicine, Graduate School of Medicine, Ehime University, Toon, Japan
| | - Tasuku Nishihara
- Department of Anesthesia and Perioperative Medicine, Graduate School of Medicine, Ehime University, Toon, Japan
| | - Tadao Morino
- Department of Orthopaedic Surgery, Graduate School of Medicine, Ehime University, Toon, Japan
| | - Keisuke Sekiya
- Department of Anesthesia and Perioperative Medicine, Graduate School of Medicine, Ehime University, Toon, Japan
| | - Sakiko Kitamura
- Department of Anesthesia and Perioperative Medicine, Graduate School of Medicine, Ehime University, Toon, Japan
| | - Amane Konishi
- Department of Anesthesia and Perioperative Medicine, Graduate School of Medicine, Ehime University, Toon, Japan
| | - Yasushi Takasaki
- Department of Anesthesia and Perioperative Medicine, Graduate School of Medicine, Ehime University, Toon, Japan
| | - Hiromasa Miura
- Department of Orthopaedic Surgery, Graduate School of Medicine, Ehime University, Toon, Japan
| | - Naoki Abe
- Department of Anesthesia and Perioperative Medicine, Graduate School of Medicine, Ehime University, Toon, Japan
| | - Toshihiro Yorozuya
- Department of Anesthesia and Perioperative Medicine, Graduate School of Medicine, Ehime University, Toon, Japan
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Kurkov AV, Shekhter AB, Paukov VS. [Costal cartilage structural and functional changes in children with a funnel or keeled chest]. Arkh Patol 2018; 79:57-62. [PMID: 29027531 DOI: 10.17116/patol201779557-62] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Congenital chest wall deformities (CCWDs) in children are severe diseases leading to cosmetic defects and diseases of the respiratory and cardiovascular systems. The most common of these deformities are funnel-shaped (pectus excavatum, FD) and keeled (pectus carinatum, KD) ones. The pathogenesis of CCWDs and the role of costal cartilage structural and functional changes in their pathogenesis have now been not well studied, which makes it difficult to elaborate pathogenetic approaches to correcting these diseases. Analysis of the literature has shown that structural and functional changes occur in the matrix and chondrocytes from the costal cartilage in FD. Similar costal cartilage changes are observed in KD. It is still unknown exactly which pathological processes are present in the costal cartilage and how they result in the development of one or other type of CCWDs. The role of amianthoid transformation (AT) of costal cartilages in these processes is also unknown. It is not improbable that it is AT drastically changing the native cartilage matrix, which is one of the key mechanisms leading to changes in its properties and to the subsequent development of FD or KD.
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Affiliation(s)
- A V Kurkov
- Institute for Regenerative Medicine, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia; Acad. A.I. Strukov Department of Pathological Anatomy, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia; Institute of Photonic Technologies, Federal Research Center of Crystallography and Photonics, Russian Academy of Sciences, Moscow, Russia
| | - A B Shekhter
- Institute for Regenerative Medicine, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia; Institute of Photonic Technologies, Federal Research Center of Crystallography and Photonics, Russian Academy of Sciences, Moscow, Russia
| | - V S Paukov
- Acad. A.I. Strukov Department of Pathological Anatomy, I.M. Sechenov First Moscow State Medical University, Ministry of Health of Russia, Moscow, Russia
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Kragten H, Höppener P, Gielis A, de Booij M. Pectus excavatum severity underestimated due to lack of objective measures in radiological reports. BMJ Case Rep 2016; 2016:bcr-2015-213904. [PMID: 27217048 DOI: 10.1136/bcr-2015-213904] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
During a routine physical examination, the degree of pectus excavatum (PE) is not always appreciated as the external appearance does not always reflect the severity of the deformity. In the patient in this case report, the severity had been underestimated for 33 years. The physicians, having requested standard two-view chest radiographs, had relied solely on the radiological reports, where the PE had been ambiguously described as 'moderate' or 'substantial'. In patients where PE has been observed, it is essential that an objective numeric measure of severity, using the Haller index, is included in radiological reports.
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Affiliation(s)
- Hans Kragten
- Department of Cardiology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Paul Höppener
- Department of Research, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Albert Gielis
- Department of Cardiology, Zuyderland Medical Centre, Heerlen, The Netherlands
| | - Machiel de Booij
- Department of Radiology, Zuyderland Medical Centre, Heerlen, The Netherlands
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Sacco Casamassima MG, Papandria D, Goldstein SD, Yang J, McIltrot KH, Abdullah F, Colombani PM. Contemporary management of recurrent pectus excavatum. J Pediatr Surg 2015; 50:1726-33. [PMID: 25962841 DOI: 10.1016/j.jpedsurg.2015.04.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2014] [Revised: 04/09/2015] [Accepted: 04/18/2015] [Indexed: 11/27/2022]
Abstract
BACKGROUND Optimal management of recurrent pectus excavatum (PE) has not been established. Here, we review our institutional experience in managing recurrent PE to evaluate long-term outcomes and propose an anatomic classification of recurrences, and a decision-making algorithm. METHODS Clinical records of patients undergoing repair of recurrent PE (1996-2011) were reviewed. Univariate and multivariate logistic regression analyses were employed to examine patient characteristics as potential predictors for re-recurrence. RESULTS Eighty-five patients with recurrent PE were identified during the study period. The initial operation was a Ravitch procedure in 85% of cases. Revision procedures were most frequently Nuss repairs (N=73, 86%), with remaining cases managed via open approach. Overall cosmetic and functional results were satisfactory in 67 patients (91.8%) managed with Nuss and in 7 (58%) patients managed with other techniques. Seven (8%) patients required additional surgical revision. Multivariate analysis identified no statistically significant patient or procedural factors predictive of re-recurrence. CONCLUSION This study demonstrates that the Nuss procedure can be an effective intervention for recurrent pectus excavatum, regardless of the initial repair technique. However, open repair remains valuable when managing severe cases with abnormalities of the sternocostal junction and cartilage regrowth under the sternum.
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Affiliation(s)
| | - Dominic Papandria
- Department of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Seth D Goldstein
- Department of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jingyan Yang
- Department of Health, Behavior &Society, Johns Hopkins Bloomberg School of Public Health, MD, USA
| | - Kimberly H McIltrot
- Department of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Fizan Abdullah
- Department of Pediatric Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Paul M Colombani
- Department of Pediatric Surgery, All Children's Hospital Johns Hopkins, St Petersburg, FL, MD, USA.
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Correction of secondary deformity after Nuss procedure for pectus excavatum by means of cultured autologous cartilage cell injection. Int J Surg Case Rep 2015; 15:70-3. [PMID: 26318131 PMCID: PMC4601972 DOI: 10.1016/j.ijscr.2015.08.031] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2015] [Accepted: 08/15/2015] [Indexed: 11/25/2022] Open
Abstract
Different strategies are available for the re-correction after pectus excavatum surgery. We cultured and propagated chondrocytes taken from a patient’s auricular cartilage. The cultured chondrocytes are transplanted to the concave part of the chest. The chest shape improved and the transplanted cells consolidated, forming part of the chest wall. Transplantation of cultured chondrocytes is a useful treatment for pectus excavatum.
Introduction For some cases of pectus excavatum, ideal chest shape cannot be achieved solely by performing the Nuss procedure. This manuscript presents a case where the residual deformity following Nuss was corrected using injection-transplantation of cultured autologous chondrocytes. Presentation of case The treatment was performed for an 18-year-old male, who sought improvement of his chest shape after previously undergoing the Nuss procedure. A 1 cm2 auricular cartilage piece was harvested from his ear. Chondrocytes were isolated from the cartilage piece and were cultured. The cultured chondrocytes were processed into gel form and were injection-transplanted to the deformed region of the patient's chest. The grafted chondrocytes consolidated in one month, presenting elasticity equivalent to ordinary costal cartilage. The patient's chest remains in an optimal shape after a one-year postoperative follow up. Discussion Secondary correction of the chest deformity after previous operation for pectus excavatum is often tricky, because of the possible adhesion of the lungs or pericardium with the thoracic wall. Transplantation of cultured autologous chondrocytes does not require intra-thoracic maneuvers, and so is less invasive than other surgical interventions. Hence, priority can be placed, in some cases, on the chondrocyte transplantation rather than the re-correction of the thorax with the Nuss procedure or Ravitch procedure. Conclusion Transplantation of cultured autologous chondrocytes is recommended as a useful option for secondary correction of chest deformity after the Nuss procedure.
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Facioscapulohumeral muscular dystrophy as a genetic cause of pectus excavatum. Eur J Med Genet 2015; 58:203-4. [PMID: 25725206 DOI: 10.1016/j.ejmg.2015.02.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2015] [Accepted: 02/18/2015] [Indexed: 11/23/2022]
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Yiyit N, Işıtmangil T, Öztürker C. The abnormalities of trapezius muscle might be a component of Poland’s syndrome. Med Hypotheses 2014; 83:533-6. [DOI: 10.1016/j.mehy.2014.09.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2014] [Revised: 08/26/2014] [Accepted: 09/10/2014] [Indexed: 10/24/2022]
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