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Notrica DM, McMahon LE, Jaroszewski DE. Pectus Disorders: Excavatum, Carinatum and Arcuatum. Adv Pediatr 2024; 71:181-194. [PMID: 38944483 DOI: 10.1016/j.yapd.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2024]
Abstract
This article reviews pectus excavatum, carinatum, and arcuatum. Topics covered include etiology, epidemiology, associated syndromes, physiologic impact, workup, indications for treatment, surgical and nonsurgical therapy, results, complications, and emerging therapies. Pectus excavatum is an inward deformation of the sternum and/or anterior chest wall. Pectus carinatum is ether an outward protrusion or tilt of the sternum with potential psychological impact, but no demonstrated physiologic impact. Nonoperative compression bracing is successful in carinatum patients with chest wall flexibility who are compliant with a bracing program. Pectus arcuatum is an abnormally short, fully fused sternum with a high anterior protrusion.
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Affiliation(s)
- David M Notrica
- Phoenix Children's Division of Pediatric Surgery, 1919 East Thomas Road, Phoenix, AZ 85016, USA; University of Arizona College of Medicine Phoenix, Department of Child Health and Surgery, 475 N. 5th Street Phoenix, AZ 85004, USA; Mayo Clinic School of Medicine and Science, 5757 East Mayo Boulevard, Phoenix, AZ 85054, USA.
| | - Lisa E McMahon
- Phoenix Children's Division of Pediatric Surgery, 1919 East Thomas Road, Phoenix, AZ 85016, USA; University of Arizona College of Medicine Phoenix, Department of Child Health and Surgery, 475 N. 5th Street Phoenix, AZ 85004, USA; Mayo Clinic School of Medicine and Science, 5757 East Mayo Boulevard, Phoenix, AZ 85054, USA
| | - Dawn E Jaroszewski
- Mayo Clinic School of Medicine and Science, 5757 East Mayo Boulevard, Phoenix, AZ 85054, USA; Mayo Clinic Arizona, Division of Thoracic Surgery, 5757 East Mayo Boulevard, Phoenix, AZ 85054, USA
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Jaroszewski DE, Bostoros P, Farina JM, Botros MM, Aly MR, Peterson M, Lackey J, Pulivarthi KV, Smith B, Craner R, Stearns JD. Evolution of Pain Control for Adult Pectus Excavatum Repair. Ann Thorac Surg 2024; 117:829-837. [PMID: 37279827 DOI: 10.1016/j.athoracsur.2023.04.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 03/31/2023] [Accepted: 04/10/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND Pain control after minimally invasive repair of pectus excavatum (MIRPE) can be challenging, especially in adult patients undergoing surgical repair. This study reviewed different analgesic modalities used over ≥10 years after pectus repair. METHODS A retrospective analysis was performed of adult patients (≥18 years) who underwent uncomplicated primary MIRPE at a single institution from October 2010 to December 2021. Patients were classified by analgesic modality used: epidural, elastomeric continuous infusion subcutaneous catheters (SC-Caths), and intercostal nerve cryoablation. Comparisons among the 3 groups were performed. RESULTS In total, 729 patients were included (mean age, 30.9 ±10.3 years; 67% male; mean Haller index, 4.9 ±3.0). Patients in the cryoablation group required significantly lower doses of morphine equivalents (P < .001) and had overall the shortest hospital stay (mean, 1.9 ±1.5 days; P < .001) with <17% staying >2 days (vs epidural at 94% and SC-Cath at 48%; P < .001). The cryoablation group had a lower incidence of ileus and constipation (P < .001) but a higher incidence of pleural effusion requiring thoracentesis (P = .024). Mean pain scores among groups were minor (<3), and differences were insignificant. CONCLUSIONS The use of cryoablation in conjunction with enhanced recovery pathways provided significant benefit to our patients undergoing MIRPE compared with previous analgesic modalities. These benefits included a decrease in length of hospital stay, a reduction of in-hospital opioid use, and a lower incidence of opioid-related complications associated with constipation and ileus. Further studies to assess additional potential benefits with long-term follow-up after discharge are warranted.
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Affiliation(s)
- Dawn E Jaroszewski
- Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, Arizona.
| | - Peter Bostoros
- Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, Arizona
| | - Juan M Farina
- Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, Arizona
| | - Michael M Botros
- Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, Arizona
| | - Mohamed R Aly
- Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, Arizona
| | - Michelle Peterson
- Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, Arizona
| | - Jesse Lackey
- Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, Arizona
| | - Krishna V Pulivarthi
- Department of Cardiovascular and Thoracic Surgery, Mayo Clinic, Phoenix, Arizona
| | - Bradford Smith
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona
| | - Ryan Craner
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona
| | - Joshua D Stearns
- Department of Anesthesiology and Perioperative Medicine, Mayo Clinic, Phoenix, Arizona
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Frongia G, Seitz O, Chatzisideris S, Mastorakis A. Is pregnancy safe with an implanted pectus bar? An uneventful pregnancy with implanted pectus bar following correction of pectus excavatum. BMJ Case Rep 2024; 17:e255568. [PMID: 38553016 PMCID: PMC10982776 DOI: 10.1136/bcr-2023-255568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/02/2024] Open
Abstract
Limited data are available on the implications on pregnancy following pectus bar implantation for correction of pectus excavatum (Nuss procedure), while the pectus bars are in place. Limited data is also available on long-term reproductive implications following pectus bar removal.Providers at times need to consider the necessity to counsel a woman desiring pectus excavatum correction and pregnancy whether to postpone one of the two in favour of the other.We present the case of a woman of reproductive age with an uneventful pregnancy and delivery while carrying an implanted pectus bar and subsequent uneventful pregnancy and delivery after bar removal.
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Affiliation(s)
- Giovanni Frongia
- Paediatric Surgery, Schwarzwald-Baar Klinikum Villingen-Schwenningen GmbH, Villingen-Schwenningen, Baden-Württemberg, Germany
| | - Oliver Seitz
- Paediatric Surgery, Schwarzwald-Baar Klinikum Villingen-Schwenningen GmbH, Villingen-Schwenningen, Baden-Württemberg, Germany
| | - Sideris Chatzisideris
- Paediatric Surgery, Schwarzwald-Baar Klinikum Villingen-Schwenningen GmbH, Villingen-Schwenningen, Baden-Württemberg, Germany
| | - Avraam Mastorakis
- Paediatric Surgery, Schwarzwald-Baar Klinikum Villingen-Schwenningen GmbH, Villingen-Schwenningen, Baden-Württemberg, Germany
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Dreher C, Reinsberg M, Oetzmann von Sochaczewski C, Siebert S, Strohm J, Kurz R, Ziegler AM, Heydweiller A, Yavuz ST. Changes in Pulmonary Functions of Adolescents with Pectus Excavatum Throughout the Nuss Procedure. J Pediatr Surg 2023; 58:1674-1678. [PMID: 36935229 DOI: 10.1016/j.jpedsurg.2023.02.057] [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] [Received: 10/16/2022] [Revised: 02/01/2023] [Accepted: 02/15/2023] [Indexed: 03/21/2023]
Abstract
BACKGROUND We aimed to determine the longitudinal changes in pulmonary functions of adolescents with Pectus Excavatum who underwent the Nuss procedure, the minimally invasive repair of pectus excavatum (MIRPE). METHODS Lung function measurements were performed before bar implantation (T0), at least six weeks to ten months after implantation (T1a), at least eleven months to sixty-one months after bar implantation (T1b) and at least two weeks after bar explantation (T2). RESULTS Data of 114 patients (83.3% male) whose median age at implantation was 15.6 years and at explantation 18.7 years were analyzed. Shortly after implantation at T1a a significant decline of vital capacity (VC; n = 82), forced vital capacity (FVC; n = 78) and forced expiratory volume in 1 second (FEV1; n = 80) compared to T0 was seen. At T1b a significant decline for the residual volume (RV; n = 83), the residual volume/total lung capacity ratio (RV/TLC; n = 81), the total specific airway resistance (sRaw; n = 80) and the total airway resistance (Raw; n = 84) also compared to T0 was measured. In the comparison of T1b to T2 a significant increase of VC, FVC (n = 67), FEV1 (n = 69), TLC (n = 67) and a significant decrease of Raw (n = 66), sRaw, RV (n = 65) and the RV/TLC (n = 64) ratio could be observed. In the direct analysis between T0 and T2, after the explantation of the bar a significant increase in VC (n = 54), FVC (n = 52), and TLC (n = 55) and a significant decrease of RV (n = 51) and the RV/TLC index (n = 50), and in airway resistance parameters like Raw (n = 52) and sRaw (n = 51) could be detected. CONCLUSIONS Lung function values along with markers of airway resistance improve in patients after the complete procedure of MIRPE. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Charlotte Dreher
- Department of Pediatric Allergy, Children's Hospital, University of Bonn, Bonn, Germany
| | - Max Reinsberg
- Department of Pediatric Allergy, Children's Hospital, University of Bonn, Bonn, Germany
| | | | - Stephanie Siebert
- Department of Pediatric Allergy, Children's Hospital, University of Bonn, Bonn, Germany
| | - Joanna Strohm
- Department of Pediatric Surgery, Children's Hospital, University of Bonn, Bonn, Germany
| | - Ralf Kurz
- Department of Pediatric Surgery, Children's Hospital, University of Bonn, Bonn, Germany
| | - Anna-Maria Ziegler
- Department of Pediatric Surgery, Children's Hospital, University of Bonn, Bonn, Germany
| | - Andreas Heydweiller
- Department of Pediatric Surgery, Children's Hospital, University of Bonn, Bonn, Germany
| | - Suleyman Tolga Yavuz
- Department of Pediatric Allergy, Children's Hospital, University of Bonn, Bonn, Germany.
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Neurolysis for analgesia following pectus repair in a national cohort. J Pediatr Surg 2022; 57:315-318. [PMID: 35339278 DOI: 10.1016/j.jpedsurg.2022.02.008] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2021] [Revised: 02/11/2022] [Accepted: 02/14/2022] [Indexed: 11/23/2022]
Abstract
INTRODUCTION Pectus excavatum and pectus carinatum are the most common chest wall deformities of childhood. Surgical repair can be complicated by post-operative analgesic challenges. Thoracic epidural analgesia, patient-controlled analgesia, and multimodal pain control are among the most common strategies. We sought to define the current utilization of intraoperative thoracic neurolysis, hypothesizing that this would minimize length of stay (LOS) and post-operative narcotic use with relatively higher proportion of non-narcotic post-operative analgesia. METHODS We performed a retrospective review of the Pediatric Health Information System (PHIS) database between 2017 and 2020. We first identified patients who underwent a pectus repair via ICD-10-PCS codes. We used ICD-10-PCS codes 01580ZZ and 01584ZZ to identify those patients who underwent concomitant thoracic neurolysis. Statistical analyses were performed using R; p value less than 0.05 was considered significant. RESULTS We identified 2979 patients who underwent a pectus repair. 184 underwent a concomitant thoracic nerve destruction procedure (6.7%); 13 were performed in 2017 (2.01%), 76 in 2018 (10.7%), and 84 in 2019 (9.6%). LOS was shorter in those patients who underwent neurolysis (mean=2.55 vs 3.73 days, SD=1.33 vs 1.78 days, p<0.001). There were fewer post-operative ICU admissions in neurolysis patients (3/184 vs. 193/2795, p = 0.003). The cost of procedures that included a neurolysis were higher, though not significantly so (mean=$24,885.64 vs $22,200.59). CONCLUSION Thoracic neurolysis may be a useful analgesic strategy, expediating post-operative discharge and potentially obviating the need for intensive care. Further larger-scale prospective trials should be considered to further elucidate the role of this analgesia method. LEVEL OF EVIDENCE Level III.
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Chavoin JP, Facchini F, Martinot-Duquennoy V, Duteille F, Herlin C, Le Pimpec-Barthes F, Assouad J, Chevallier B, Tiffet O, Brouchet L, Leyx P, Grolleau-Raoux JL, Chaput B, Dahan M. [Congenital thoracic deformities and 3D custom-made implants. New classification based on a series of 789 treated cases]. ANN CHIR PLAST ESTH 2022; 67:393-403. [PMID: 36031493 DOI: 10.1016/j.anplas.2022.07.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The authors present a new study on 789 cases of congenital thoracic malformations including 638 pectus excavatum and 151 Poland syndromes, according to a new classification which completes Chin's one. All these malformations were treated with silicone elastomer implants. The contribution of computer-aided design and manufacturing (CAD/CAM) since 2008 is essential. The one-stage surgical protocol is precisely described. The results are impressive, permanent, for life, and complications are rare. The authors evoke a common vascular etiopathogenesis theory at the embryonic stage and question the heavy techniques of invasive remodeling that are most often unjustified.
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Affiliation(s)
- J P Chavoin
- Service de chirurgie Plastique Reconstructrice et esthétique,Centre Hospitalier Universitaire de Toulouse-Rangueil, 1, avenue Jean Pouilhès, 31059, Toulouse, France.
| | - F Facchini
- Service de Chirurgie Pédiatrique, Hôpital Universitaire pédiatrique Meyer, Viale Gaetano Pieraccini, 24, 50139, Florence, Italie.
| | - V Martinot-Duquennoy
- Service de Chirurgie plastique reconstructrice et Esthétique CHU Hôpital Salengro, Avenue du Professeur Emile Laine, 59037, Lille, France.
| | - F Duteille
- Service de Chirurgie Plastique Reconstructrice et Esthétique, Centre des brûlés, CHU Hôtel Dieu, 1 Pl. Alexis-Ricordeau, 44039, Nantes, France.
| | - C Herlin
- Service de Chirurgie Plastique Reconstructrice et Esthétique CHU, Hôpital Lapeyronie, 371, avenue du Doyen Gaston Giraud, 34295, Montpellier, France.
| | - F Le Pimpec-Barthes
- Service de Chirurgie Thoracique et Transplantation pulmonaire Hôpital Européen Georges Pompidou, 20 rue Leblanc, 75015, Paris, France.
| | - J Assouad
- Service de Chirurgie Thoracique et Cardio-Vasculaire APHP Hôpital Tenon, 4 rue de la Chine, 75020, Paris, France.
| | - B Chevallier
- Service de chirurgie thoracique et cervicale et transplantation pulmonaire Hôpital Haut-Lévêque CHU de Bordeaux, 33600, Pessac, France.
| | - O Tiffet
- Service de Chirurgie Générale et thoracique CHU Saint Etienne, Avenue Albert Raimond, 42270, Saint-Priest-en-Jarez, France.
| | - L Brouchet
- Service de Chirurgie Thoracique, Chu Hôpital Larrey, 24 Chem. de Pouvourville, 31400, Toulouse, France.
| | - P Leyx
- Ingénieur CAO Anatomik Modeling SAS, 19 rue Jean Mermoz, 31100, Toulouse, France.
| | - J L Grolleau-Raoux
- Service de Chirurgie plastique reconstructrice et Esthétique CHU Rangueil, 1 rue Jean Poulhès, 31054, Toulouse, France.
| | - B Chaput
- Service de Chirurgie plastique reconstructrice et Esthétique CHU Rangueil, 1 rue Jean Poulhès, 31054, Toulouse, France.
| | - M Dahan
- Service de Chirurgie Thoracique, Chu Hôpital Larrey, 24 Chem. de Pouvourville, 31400, Toulouse, France.
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Skoczyński S, Kudela G, Brożek G, Lawson J, Tobor S, Skoczyńska A, Swinarew A, Trejnowska E, Winnicki IR, Repetowska K, Paluch J, Barczyk A, Koszutski T. Pulmonary function, exercise capacity and dyspnea in patients 7 years after Nuss surgery. Adv Med Sci 2022; 67:179-186. [PMID: 35306355 DOI: 10.1016/j.advms.2022.02.008] [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: 07/21/2021] [Revised: 01/23/2022] [Accepted: 02/28/2022] [Indexed: 11/01/2022]
Abstract
PURPOSE Pectus excavatum is a frequent thoracic malformation increasingly treated with minimally invasive methods (MIRPE), which are performed for cardio-respiratory problems and in some centers also for esthetic considerations. Theoretically, MIRPE may increase thoracic elastic recoil, work of breathing and cause emphysema. The aim of the present study was to determine whether teenagers who underwent MIRPE may expect normal thoracic cage development, cardio-respiratory function, exercise capacity and asymptomatic functioning. MATERIAL AND METHODS Fifty five patients (21.1 ± 3.0 years) who underwent MIRPE between 2000 and 2010 were assessed 6.8 (±2.4) years after surgery. Controls were matched for sex, age and height to the intervention participants. Spirometry, body plethysmography, diffusion capacity and the 6 min walking test (6MWT) were performed. Anteroposterior (AP) and transverse chest diameters were measured. RESULTS Participants who underwent MIRPE had normal pulmonary function, and exercise capacity. After adjustment for potential confounders, the intervention group had lower mean BMI [-1.88 ± 0.56 (kg/m2); p = 0.001] and chest AP diameter [-2.79 ± 0.57 (cm); p < 0.001], but higher residual volume (RV%) [12.98 ± 5.31 (%); p = 0.001], RV% total lung capacity (TLC) [5.56 ± 0.92 (%); p < 0.001], forced expiratory volume in 1 s/forced vital capacity (FEV1/FVC) [2.64 ± 1.28 (%); p = 0.039] and 6MWT distance [29.10 ± 13.02 (m); p = 0.025]. CONCLUSIONS Young adults who undergo MIRPE may expect normal pulmonary function and exercise capacity. Observed differences in air trapping require further assessment in terms of emphysema development risk.
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Alqadi GO, Saxena AK. Analysis of Psychological Assessments Affecting Patients Undergoing Treatment for Chest Wall Deformities. Am Surg 2021:31348211038585. [PMID: 34382882 DOI: 10.1177/00031348211038585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIM This study aimed to review the literature with regard to the psychological aspects in patients with pectus excavatum (PE) and pectus carinatum (PC). METHODS The literature was reviewed by analyzing articles on PubMed using the search terms "psychology" and "pectus." RESULTS The literature search revealed 22 articles that offered a total of 2214 patients for analysis. Regarding chest wall deformities (CWD), there were 15 articles referring to PE, 4 articles on PC, and 3 pertaining to both PE and PC. Authors used various types of questionnaires and 14 studies which also included a parent questionnaire. There are 14 reports which analyzed both the preoperative and postoperative psychological status and 4 reports in which a control group was used. Treatment of CWD was shown to have consistently positive results. There is no consensus regarding the correlation between severity of CWD and psychological issues. Only 2 studies found no statistically significant results after treatment. CONCLUSIONS The literature reveals a great concern for psychosocial issues in CWD patients. Most articles describe improvement in overall quality of life (QOL) after surgery. An increase in social and physical function, body image, and self-esteem was observed in CWD patients, which is supported by parent responses.
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Affiliation(s)
- Gratiana O Alqadi
- Department of Pediatric Surgery, Chelsea Children's Hospital, 9762Chelsea and Westminster Hospital NHS Fdn Trust, Imperial College London, London, UK.,Department of Pediatric Surgery, 87267University of Medicine and Pharmacy "Carol Davila", Bucharest, Romania
| | - Amulya K Saxena
- Department of Pediatric Surgery, Chelsea Children's Hospital, 9762Chelsea and Westminster Hospital NHS Fdn Trust, Imperial College London, London, UK
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Guillot MS, Rouchaud A, Mounayer C, Tricard J, Belgacem A, Auditeau E, Omraam O, Fourcade L, Ballouhey Q. X-ray-free protocol for pectus deformities based on magnetic resonance imaging and a low-cost portable three-dimensional scanning device: a preliminary study. Interact Cardiovasc Thorac Surg 2021; 33:110-118. [PMID: 33657219 DOI: 10.1093/icvts/ivab036] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Revised: 12/01/2020] [Accepted: 01/10/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES To compare a standard protocol using chest computed tomography (CT) to a non-irradiant protocol involving a low-cost portable 3D scanner and magnetic resonance imaging (MRI) for all pectus deformities based on the Haller index (HI). METHODS From April 2019 to March 2020, all children treated for pectus excavatum or carinatum at our institution were evaluated by chest CT, 3D scanning (iPad with Structure Sensor and Captevia-Rodin4D) and MRI. The main objectives were to compare the HI determined by CT or MRI to a derived index evaluated with 3D scanning, the external Haller index (EHI). The secondary objectives were to assess the inter-rater variability and the concordance between CT and MRI for the HI and the correction index. RESULTS Eleven patients were evaluated. We identified a strong correlation between the HI with MRI and the EHI (Pearson correlation coefficient = 0.900; P < 0.001), with a strong concordance between a radiologist and a non-radiologist using intra-class correlation for the HI with MRI (intra-class correlation coefficient = 0.995; [0.983; 0.999]) and the EHI (intra-class correlation coefficient = 0.978; [0.823; 0.995]). We also identified a marked correlation between the HI with CT and the EHI (Pearson coefficient = 0.855; P = 0.002), with a strong inter-rater concordance (intra-class correlation coefficient = 0.975; [0.901; 0.993]), a reliable concordance between CT and MRI for the HI and the correction index (Pearson coefficient = 0.886; P = 0.033). CONCLUSIONS Non-irradiant pectus deformity assessment is possible in clinical practice, replacing CT with MRI and 3D scanning as a possible readily-accessible monitoring tool.
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Affiliation(s)
| | - Aymeric Rouchaud
- Department of Radiology, Limoges University Hospital, Limoges, France
| | - Charbel Mounayer
- Department of Radiology, Limoges University Hospital, Limoges, France
| | - Jérémy Tricard
- Department of Thoracic Surgery, Limoges University Hospital, Limoges, France
| | - Alexis Belgacem
- Department of Pediatric Surgery, Limoges University Hospital, Limoges, France
| | - Emilie Auditeau
- INSERM, Limoges University Hospital, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France.,Department of Epidemiology, Limoges University Hospital, Limoges, France
| | - Olivier Omraam
- INSERM, Limoges University Hospital, IRD, U1094 Tropical Neuroepidemiology, Institute of Epidemiology and Tropical Neurology, GEIST, Limoges, France.,Department of Epidemiology, Limoges University Hospital, Limoges, France
| | - Laurent Fourcade
- Department of Pediatric Surgery, Limoges University Hospital, Limoges, France
| | - Quentin Ballouhey
- Department of Pediatric Surgery, Limoges University Hospital, Limoges, France
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Norlander L, Karlsson J, Anderzén-Carlsson A, Vidlund M, Dreifaldt M, Andreasson J, Sundqvist AS. Translation and psychometric evaluation of the Swedish versions of the Nuss Questionnaire modified for Adults and the Single Step Questionnaire. J Patient Rep Outcomes 2021; 5:21. [PMID: 33629190 PMCID: PMC7904978 DOI: 10.1186/s41687-021-00293-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2020] [Accepted: 02/02/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Pectus excavatum (PE) is the most common congenital chest wall deformity. Most individuals with PE suffer from psychosocial problems, with low self-esteem and poor body image. Correctional surgery for PE is available, the most widely used is the Nuss procedure. The Nuss procedure has previously been reported to improve self-esteem, body image and health-related quality of life (HRQoL). To assess HRQoL among individuals with PE, the Nuss Questionnaire modified for Adults (NQ-mA) and Single Step Questionnaire (SSQ) has been developed. The aim of the current study was to translate and culturally adapt NQ-mA and SSQ to fit a Swedish context, and to evaluate the psychometric properties, and validate the culturally adapted versions. METHODS Individuals who had undergone the Nuss procedure for pectus excavatum were invited to participate in a multicentre study with cross-sectional design. HRQoL was assessed by NQ-mA, SSQ and RAND-36. Psychometric properties for NQ-mA and SSQ were evaluated by content validity index and construct validity (exploratory factor analysis, confirmatory factor analysis, and inter-scale correlations). Known-groups validity, as well as floor and ceiling effects, were evaluated. Internal consistency reliability was examined using Cronbach's alpha. RESULTS In total 236 individuals participated in the study. Content validity index for NQ-mA showed satisfactory results, except for two items. Factor analysis for NQ-mA suggested a two-factor model, with exclusion of two items. Subscales correlated adequately with RAND-36's domains. Known-groups validity for NQ-mA demonstrated high sensitivity for between-group differences. Ceiling effects were present in several items. Cronbach's alpha for NQ-mA was .89. Confirmatory factor analysis for SSQ resulted in a three-factor model, with exclusion of five items. However, this model was shown to be unstable through further exploratory factor analysis testing, and no further psychometric tests were conducted for SSQ. CONCLUSION The 10-item Swedish version of NQ-mA was shown to be valid for research and clinical assessment of HRQoL in individuals with pectus excavatum. The Swedish version of SSQ requires revision of items before further validation can be performed.
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Affiliation(s)
- Louise Norlander
- Faculty of Medicine and Health, School of Health Sciences, Örebro University, Örebro, Sweden. .,Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.
| | - Jan Karlsson
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Agneta Anderzén-Carlsson
- University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
| | - Mårten Vidlund
- Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden
| | - Mats Dreifaldt
- Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden
| | - Jesper Andreasson
- Department of Cardiothoracic Surgery, Skåne University Hospital, Lund University, Lund, Sweden
| | - Ann-Sofie Sundqvist
- Department of Cardiothoracic and Vascular Surgery, Örebro University Hospital, Örebro, Sweden.,University Health Care Research Center, Faculty of Medicine and Health, Örebro University, Örebro, Sweden
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11
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Determinants of electrocardiographic abnormalities in patients with pectus excavatum. J Electrocardiol 2021; 65:91-95. [PMID: 33582499 DOI: 10.1016/j.jelectrocard.2021.01.015] [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: 12/21/2020] [Revised: 01/20/2021] [Accepted: 01/27/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND Electrocardiographic abnormalities such as cardiac axis deviation, conduction abnormalities and ST-segment, and T &P wave abnormalities have been reported in patients with pectus excavatum. The precise determinants of these electrocardiographic abnormalities have however not been systematically evaluated. We therefore carried out this exploratory study to assess the electrocardiographic abnormalities and their determinants in children and young adults with pectus excavatum. METHODS Patients aged between 6 and 22 years with unrepaired pectus excavatum were eligible for enrollment in this preliminary hypothesis generating study, if they were seen at University of Chicago Medical Center between Jan 1, 2017 to Nov 30, 2020, and underwent an electrocardiogram during comprehensive evaluation for pectus excavatum. Pertinent data was collected from the medical charts. Unadjusted and adjusted logistic regression models were used to determine the effect of variables including age, BMI, inspiratory Haller's index, gender, right ventricular geometric distortion and FEV1/FVC (% predicted) on odds of electrocardiographic abnormalities (primary outcome variable). P-values of <0.05 were considered significant. RESULTS The study group (16.6 ± 2.9 years, 80% symptomatic) consisted of 28 patients [Caucasian, male (n = 24, 86% each)]. A high proportion (86%) of these patients had geometric distortion of the right ventricle on noninvasive imaging and these patients had a higher Haller's index (4.4 ± 0.95 vs 3.3 ± 0.2, p = 0.03). Approximately 60% of the patients had an abnormal electrocardiogram. Unadjusted and adjusted logistic regression models were utilized to study the determinants of these electrocardiographic abnormalities. Haller's index, BMI, age, gender, geometric distortion of the right ventricle and lung function parameters [FEV1/FEV (% predicted)] were not associated with increased odds of electrocardiographic abnormalities. CONCLUSIONS Electrocardiographic abnormalities, particularly deviation of cardiac axis, are common in patients with pectus excavatum. In this exploratory hypothesis generating study, Haller's index and geometric distortion of the right ventricle were not associated with these abnormalities. However, systematic multicentric efforts are needed to better define electrocardiographic abnormalities in patients with pectus excavatum and elucidate their precise determinants.
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Validating 3D indexes in the non-surgical pectus excavatum patient. J Pediatr Surg 2021; 56:230-234. [PMID: 32650999 DOI: 10.1016/j.jpedsurg.2020.06.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2020] [Revised: 05/27/2020] [Accepted: 06/04/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND/PURPOSE In recent years there has been an increased interest in three-dimensional (3D) imaging for the assessment of chest wall deformities. Some studies have proven a correlation between 3D and traditional cross-sectional images but only for patients who already had an indication for a computed tomography (CT) scan prior to surgery; mainly due to their severity. Our aim is to determine the accuracy and reliability of the measures obtained by a portable 3D scanner in a cohort of pectus excavatum (PE) patients with different severity grades, as well as in controls. METHODS We conducted a study comparing radiological and optical indexes on magnetic resonance imaging (MRI) and 3D surface images. We used a hand-held 3D scanner to obtain the optical Haller Index (3DHI) and Correction Index (3DCI) and a limited MRI scan to obtain the traditional indexes. A statistical analysis was carried out to determine the correlation between optical and radiological measures, plus a subjective severity evaluation. RESULTS Twenty-eight patients and controls were enrolled in the study. In both the control and PE groups, there was a significant positive correlation between the indexes, especially for the CI. There were no differences in correlation regarding gender, age or severity. CI appears to better discriminate amongst the different severity groups and controls. CONCLUSION 3D surface imaging is feasible and appropriate to use to assess PE, regardless of the severity or characteristics of the individual patient. Even with a small hand-held device, we can obtain accurate images and measures which are especially useful for the assessment of the nonsurgical pectus patient.
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Kurkov A, Guller A, Fayzullin A, Fayzullinа N, Plyakin V, Kotova S, Timashev P, Frolova A, Kurtak N, Paukov V, Shekhter A. Amianthoid transformation of costal cartilage matrix in children with pectus excavatum and pectus carinatum. PLoS One 2021; 16:e0245159. [PMID: 33493174 PMCID: PMC7833175 DOI: 10.1371/journal.pone.0245159] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Accepted: 12/22/2020] [Indexed: 11/21/2022] Open
Abstract
Background It is unclear if amianthoid transformation (AT) of costal cartilage extracellular matrix (ECM) has an impact on the development of pectus excavatum (PE) and pectus carinatum (PC). Methods AT foci were examined in intrasurgical biopsy specimens of costal cartilages of children (8–17 years old) with PE (n = 12) and PC (n = 12) and in age-matching autopsy control samples (n = 10) using histological and immunohistochemical staining, atomic force and nonlinear optical microscopy, transmission and scanning electron microscopy, morphometry and statistics. Results AT areas were identified in the costal cartilage ECM in children with normal chest, PE and PC. Each type of the AT areas (“canonical”, “intertwined”, “fine-fibred” and “intralacunary”) had a unique morphological pattern of thickness and alignment of amianthoid fibers (AFs). AFs were formed via lateral aggregation of collagen type II fibrils in the intact ECM. Foci of the AT were observed significantly more frequently in the PE and PC groups. The AT areas had unique quantitative features in each study group. Conclusion AT is a structurally diverse form of ECM alteration present in healthy and pathological costal cartilage. PE and PC are associated with specific AT disorders.
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Affiliation(s)
- Alexandr Kurkov
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- A.I. Strukov Department of Anatomical Pathology, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Anna Guller
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- The Graduate School of Biomedical Engineering, University of New South Wales, Sydney, New South Wales, Australia
| | - Alexey Fayzullin
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- World-Class Research Center "Digital Biodesign and Personalized Healthcare", Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- * E-mail:
| | - Nafisa Fayzullinа
- National Medical Research Center for Obstetrics, Gynecology and Perinatology Named After Academician V.I. Kulakov of the Ministry of Healthcare of the Russian Federation, Moscow, Russia
| | - Vladimir Plyakin
- Clinical and Research Institute of Emergency Pediatric Surgery and Traumatology, Moscow, Russia
| | - Svetlana Kotova
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Department of Polymers and Composites, N.N. Semenov Institute of Chemical Physics, Moscow, Russia
| | - Petr Timashev
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- World-Class Research Center "Digital Biodesign and Personalized Healthcare", Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
- Department of Polymers and Composites, N.N. Semenov Institute of Chemical Physics, Moscow, Russia
- Chemistry Department, Lomonosov Moscow State University, Moscow, Russia
| | - Anastasia Frolova
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Nikita Kurtak
- FSBI “Academician V.I. Shumakov Federal Research Center of Transplantology and Artificial Organs”, Ministry of Health of the Russian Federation, Moscow, Russia
| | - Vyacheslav Paukov
- A.I. Strukov Department of Anatomical Pathology, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
| | - Anatoly Shekhter
- Institute for Regenerative Medicine, Sechenov First Moscow State Medical University (Sechenov University), Moscow, Russia
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Liu C, Wen Y. Research progress in the effects of pectus excavatum on cardiac functions. WORLD JOURNAL OF PEDIATRIC SURGERY 2020; 3:e000142. [DOI: 10.1136/wjps-2020-000142] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/07/2020] [Accepted: 04/21/2020] [Indexed: 11/04/2022] Open
Abstract
BackgroundPectus excavatum, the most common chest wall deformity in children, accounts for nearly 90% of congenital malformations of chest wall. Initially, both parents and doctors paid more attention to the influence of this deformity on patient appearance and psychology. Following deeper studies of pectus excavatum, researchers found that it also affected cardiac functions. The purpose of this review aims to present recent research progress in the effects of pectus excavatum on cardiac functions.Data sourcesBased on aspects of CT, ultrasound cardiography (UCG) and MRI, all the recent literatures on the influence of pectus excavatum on cardiac function were searched and reviewed.ResultsModerate and severe pectus excavatum did have a negative effect on cardiac function. Cardiac rotation angle, cardiac compression index, right atrial and tricuspid annulus size, septal motion and myocardial strain are relatively effective indexes to evaluate cardiac function.ConclusionsPectus excavatum did have a negative effect on cardiac function; so surgeons should actively diagnose and treat such patients in clinical work. However, further research is needed on to explore the measures and indicators that can reflect the changes of cardiac function in patients objectively, accurately, effectively and timely.
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Capunay C, Martinez-Ferro M, Carrascosa P, Bellia-Munzon G, Deviggiano A, Nazar M, Martinez JL, Rodriguez-Granillo GA. Sternal torsion in pectus excavatum is related to cardiac compression and chest malformation indexes. J Pediatr Surg 2020; 55:619-624. [PMID: 31133283 DOI: 10.1016/j.jpedsurg.2019.05.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 04/16/2019] [Accepted: 05/10/2019] [Indexed: 11/28/2022]
Abstract
BACKGROUND/PURPOSE The role of sternal torsion (ST) in patients with pectus excavatum (PEX) is unknown. We evaluated the relationship between ST and both chest malformation and cardiac compression (CC) indexes. METHODS We included consecutive patients with PEX who underwent chest computed tomography and cardiac magnetic resonance (CMR) to define surgical candidacy. Malformation indexes included the Haller index (HI), correction index (CI), and ST. CC and the tricuspid to mitral annulus width ratio were evaluated using CMR. RESULTS One-hundred and sixteen patients were included, with a mean HI of 5.8 ± 3.6 and a mean CI of 35.8 ± 18.0%. ST was significantly related to malformation indexes, being patients with absence of ST those showing the lowest HI (p = 0.048) and CI (p = 0.002). Right-sided ST was significantly related to the CC classification (p = 0.0001), and the tricuspid/mitral annulus width ratio was significantly lower among these patients (absence 0.98 ± 0.15, left-sided 0.91 ± 0.10, right-sided 0.80 ± 0.15, p < 0.0001). A significant inverse relationship between ST degrees and the tricuspid/mitral ratio was also identified (r = -0.47, p < 0.0001). CONCLUSIONS We identified a significant relationship between ST and both chest malformation and CC indexes; the absence of ST being identified as a marker of an overall more benign phenotype. TYPE OF STUDY Study of diagnostic test. LEVEL OF EVIDENCE Level II.
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Affiliation(s)
- Carlos Capunay
- Department of Cardiovascular Imaging, Diagnostico Maipu. Buenos Aires. Argentina
| | - Marcelo Martinez-Ferro
- Department of Surgery, Fundacion Hospitalaria, Private Children's Hospital, Buenos Aires, Argentina
| | - Patricia Carrascosa
- Department of Cardiovascular Imaging, Diagnostico Maipu. Buenos Aires. Argentina
| | - Gaston Bellia-Munzon
- Department of Surgery, Fundacion Hospitalaria, Private Children's Hospital, Buenos Aires, Argentina
| | - Alejandro Deviggiano
- Department of Cardiovascular Imaging, Diagnostico Maipu. Buenos Aires. Argentina
| | - Maximiliano Nazar
- Department of Surgery, Fundacion Hospitalaria, Private Children's Hospital, Buenos Aires, Argentina
| | - Jorge Luis Martinez
- Department of Surgery, Fundacion Hospitalaria, Private Children's Hospital, Buenos Aires, Argentina
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Rodriguez-Granillo GA, Raggio IM, Deviggiano A, Bellia-Munzon G, Capunay C, Nazar M, Martinez JL, Carrascosa P, Martinez-Ferro M. Impact of pectus excavatum on cardiac morphology and function according to the site of maximum compression: effect of physical exertion and respiratory cycle. Eur Heart J Cardiovasc Imaging 2020; 21:77-84. [DOI: 10.1093/ehjci/jez061] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2023] Open
Abstract
Abstract
Aims
Previous studies have demonstrated diverse cardiac manifestations in patients with pectus excavatum (PEX), although mostly addressing morphological or physiological impact as separate findings. Using multimodality imaging, we evaluated the impact of PEX on cardiac morphology and function according to the site of maximum compression, and the effect of exertion and breathing.
Methods and results
All patients underwent chest computed tomography, cardiac magnetic resonance (CMR), and stress echocardiography (echo) in order to establish surgical candidacy. We evaluated diastolic function and trans-tricuspid gradient during stress (echo); and systolic function and respiratory-related septal wall motion abnormalities (CMR). Patients were classified according to the site of cardiac compression as type 0 (without cardiac compression); type 1 (right ventricle); and type 2 [right ventricle and atrioventricular (AV) groove]. Fifty-nine patients underwent multimodality imaging, with a mean age of 19.5 ± 5.9 years. Compared with a sex and age matched control group, peak exercise capacity was lower in patients with PEX (8.4 ± 2.0 METs vs. 15.1 ± 4.6 METs, P < 0.0001). At stress, significant differences were found between groups regarding left ventricular E/A (P = 0.004) and e/a ratio (P = 0.005), right ventricular E/A ratio (P = 0.03), and trans-tricuspid gradient (P = 0.001). At CMR, only 9 (15%) patients with PEX had normal septal motion, whereas 17 (29%) had septal flattening during inspiration. Septal motion abnormalities were significantly related to the cardiac compression classification (P < 0.0001).
Conclusions
The present study demonstrated that patients with PEX, particularly those with compression affecting the right ventricle and AV groove, manifest diverse cardiac abnormalities that are mostly related to exertion, inspiration, and diastolic function.
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Affiliation(s)
- Gaston A Rodriguez-Granillo
- Department of Cardiovascular Imaging, Diagnostico Maipu, Av. Maipú 1668, Vicente López (B1602ABQ), Buenos Aires, Argentina
| | - Ignacio M Raggio
- Department of Cardiology, Clinica Olivos and CEMIC, Av. Maipú 1660, Vicente López (B1602ABQ), Buenos Aires, Argentina
| | - Alejandro Deviggiano
- Department of Cardiovascular Imaging, Diagnostico Maipu, Av. Maipú 1668, Vicente López (B1602ABQ), Buenos Aires, Argentina
| | - Gaston Bellia-Munzon
- Department of Surgery, Fundacion Hospitalaria, Private Children's Hospital, Av. Crámer 4601, C1429AKK, Buenos Aires, Argentina
| | - Carlos Capunay
- Department of Cardiovascular Imaging, Diagnostico Maipu, Av. Maipú 1668, Vicente López (B1602ABQ), Buenos Aires, Argentina
| | - Maximiliano Nazar
- Department of Surgery, Fundacion Hospitalaria, Private Children's Hospital, Av. Crámer 4601, C1429AKK, Buenos Aires, Argentina
| | - Jorge Luis Martinez
- Department of Surgery, Fundacion Hospitalaria, Private Children's Hospital, Av. Crámer 4601, C1429AKK, Buenos Aires, Argentina
| | - Patricia Carrascosa
- Department of Cardiovascular Imaging, Diagnostico Maipu, Av. Maipú 1668, Vicente López (B1602ABQ), Buenos Aires, Argentina
| | - Marcelo Martinez-Ferro
- Department of Surgery, Fundacion Hospitalaria, Private Children's Hospital, Av. Crámer 4601, C1429AKK, Buenos Aires, Argentina
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Preoperative multimodality imaging of pectus excavatum: State of the art review and call for standardization. Eur J Radiol 2019; 117:140-148. [DOI: 10.1016/j.ejrad.2019.06.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Revised: 06/10/2019] [Accepted: 06/13/2019] [Indexed: 02/03/2023]
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Özkaya M, Bilgin M. Minimally invasive repair of the severe pectus excavatum in an infant. JOURNAL OF PEDIATRIC SURGERY CASE REPORTS 2019. [DOI: 10.1016/j.epsc.2019.101246] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
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Kauffman JD, Benzie AL, Snyder CW, Danielson PD, Chandler NM. Short-term Outcomes After Pectus Excavatum Repair in Adults and Children. J Surg Res 2019; 244:231-240. [PMID: 31301479 DOI: 10.1016/j.jss.2019.06.069] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2019] [Revised: 03/30/2019] [Accepted: 06/14/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Pectus excavatum is a common congenital chest wall deformity often repaired during adolescence, although a subset of patients undergo repair as adults. The goal of our study was to determine the effects of age at repair and repair technique on short-term surgical outcomes. MATERIALS AND METHODS We performed a cohort study of patients in the 2012 to 2016 American College of Surgeons National Surgical Quality Improvement Project pediatric (age<18 y) and adult databases who underwent pectus excavatum repair. The primary outcome was the incidence of 30-d complications. Secondary outcomes included length of stay, reoperation, and readmission. Multivariable logistic regression was used to estimate the independent effects of patient age and type of repair on postoperative outcomes. RESULTS Of the 2268 subjects included, 2089 (92.1%) were younger than 18 y. Overall, 3.4% of patients suffered a 30-d complication, and the risk was similar between age groups (risk ratio [RR], 0.69; 95% confidence interval [CI], 0.08-5.03; P = 0.731). Steroid therapy was an independent risk factor for complications (RR, 8.0; 95% CI, 1.9-19.7; P = 0.006). Median length of stay was 4 d (interquartile range, 3-5) and was similar between age groups. Risk for readmission and reoperation were 2.8% and 1.5%, respectively, and were similar for pediatric and adult patients. When comparing minimally invasive repair with and without thoracoscopy, risk for 30-d complications was lower among patients repaired with thoracoscopy (RR, 0.56; CI, 0.32-0.96; P = 0.034). CONCLUSIONS Pediatric and adult patients experience comparable rates of postoperative complications, readmission, and reoperation after pectus excavatum repair. Use of thoracoscopy during minimally invasive repair is associated with lower risk of complications. These findings suggest that thoracoscopy should be used routinely for minimally invasive repair of pectus excavatum.
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Affiliation(s)
- Jeremy D Kauffman
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Annie Laurie Benzie
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Christopher W Snyder
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Paul D Danielson
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Nicole M Chandler
- Division of Pediatric Surgery, Johns Hopkins All Children's Hospital, St. Petersburg, Florida.
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