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Moossdorff M, Maesen B, den Uijl DW, Lenderink T, Franssen FAR, Vissers YLJ, de Loos ER. Case report: ventricular fibrillation and cardiac arrest provoked by forward bending in adolescent with severe pectus excavatum. EUROPEAN HEART JOURNAL-CASE REPORTS 2021; 5:ytab373. [PMID: 34738057 PMCID: PMC8564689 DOI: 10.1093/ehjcr/ytab373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 03/23/2021] [Accepted: 09/15/2021] [Indexed: 11/13/2022]
Abstract
Background Life-threatening arrhythmias have been reported in patients with severe pectus excavatum in absence of other cardiac abnormalities. Literature is scarce regarding diagnosis, cause and management of this problem, particularly regarding the question as to whether the placement of an implantable cardioverter-defibrillator (ICD) is necessary. Case summary A 19-year-old male patient with severe pectus excavatum was scheduled for elective surgical correction. During forward bending for epidural catheter placement, syncope and ventricular fibrillation (VF) occurred resulting in cardiac arrest. After successful cardiopulmonary resuscitation, extensive analysis was performed and showed no cause for VF other than cardiac compression (particularly of the left atrium, right atrium, and ventricle to a lesser degree) due to severe pectus excavatum. Postponed correction by modified Ravitch was performed without ICD placement, with an uneventful post-operative recovery. Eighteen months after surgery, the patient remains well. Upon specific request, he did remember dizzy spells when tying shoelaces. He always considered this unremarkable. Discussion In severe pectus excavatum with cardiac compression, forward bending can decrease central venous return and cardiac output, causing hypotension, arrhythmia, and cardiac arrest. In absence of structural or electric abnormalities, cardiac compression by severe pectus excavatum was considered a reversible cause of VF and ICD placement unnecessary. Patients with cardiac compression due to severe pectus excavatum may report pre-existing postural symptoms upon specific request. When these postural symptoms are present, extreme and prolonged forward bending postures should be avoided.
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Affiliation(s)
- Martine Moossdorff
- Department of Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC Heerlen, The Netherlands.,Department of Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Bart Maesen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Dennis W den Uijl
- Department of Cardiology, Maastricht University Medical Center, P. Debyelaan 25, 6229 HX Maastricht, The Netherlands
| | - Timo Lenderink
- Department of Cardiology, Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC Heerlen, The Netherlands
| | - Fleur A R Franssen
- Department of Anesthesiology, Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC Heerlen, The Netherlands
| | - Yvonne L J Vissers
- Department of Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC Heerlen, The Netherlands
| | - Erik R de Loos
- Department of Surgery, Zuyderland Medical Center, Henri Dunantstraat 5, 6419 PC Heerlen, The Netherlands
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Rehouma H, Noumeir R, Essouri S, Jouvet P. Advancements in Methods and Camera-Based Sensors for the Quantification of Respiration. SENSORS (BASEL, SWITZERLAND) 2020; 20:E7252. [PMID: 33348827 PMCID: PMC7766256 DOI: 10.3390/s20247252] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/07/2020] [Revised: 12/09/2020] [Accepted: 12/15/2020] [Indexed: 01/22/2023]
Abstract
Assessment of respiratory function allows early detection of potential disorders in the respiratory system and provides useful information for medical management. There is a wide range of applications for breathing assessment, from measurement systems in a clinical environment to applications involving athletes. Many studies on pulmonary function testing systems and breath monitoring have been conducted over the past few decades, and their results have the potential to broadly impact clinical practice. However, most of these works require physical contact with the patient to produce accurate and reliable measures of the respiratory function. There is still a significant shortcoming of non-contact measuring systems in their ability to fit into the clinical environment. The purpose of this paper is to provide a review of the current advances and systems in respiratory function assessment, particularly camera-based systems. A classification of the applicable research works is presented according to their techniques and recorded/quantified respiration parameters. In addition, the current solutions are discussed with regards to their direct applicability in different settings, such as clinical or home settings, highlighting their specific strengths and limitations in the different environments.
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Affiliation(s)
- Haythem Rehouma
- École de Technologie Supérieure, Montreal, QC H3T 1C5, Canada;
| | - Rita Noumeir
- École de Technologie Supérieure, Montreal, QC H3T 1C5, Canada;
| | - Sandrine Essouri
- CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada; (S.E.); (P.J.)
| | - Philippe Jouvet
- CHU Sainte-Justine, Montreal, QC H3T 1C5, Canada; (S.E.); (P.J.)
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Physician-Estimated Depth as a Screening Tool for Computed Tomography Evaluation of Pectus Excavatum. J Surg Res 2020; 256:687-692. [PMID: 32451117 DOI: 10.1016/j.jss.2020.03.072] [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] [Received: 12/05/2019] [Revised: 02/21/2020] [Accepted: 03/26/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Pectus excavatum (PE) is the most common congenital chest wall anomaly with a reported incidence of 1/300 to 1/400 live births and a male predominance. Preoperative evaluation of defect severity typically requires a calculation of the Haller index (HI) and/or correction index (CI) using computed tomography (CT) or x-rays. The purpose of this study was to determine whether physician-estimated depth (PED), a bedside screening tool, could be used to identify a subset of pediatric patients in whom CT was unnecessary. METHODS After institutional review board approval (IRB #032018-091), we retrospectively reviewed all patients with a diagnosis of PE between 2009 and 2018 at our academic pediatric center. Demographic information including age, sex, and body mass index were abstracted. Imaging was reviewed to obtain HI and CI and to retrospectively calculate PED. The PED is calculated at the bedside by measuring the depth of the pectus at the site of greatest depression relative to a horizontal surface laid across the deformity. For this retrospective study, we calculated the CT-derived PED by measuring the depth from the horizontal on the respective CT images. Patients without imaging studies and patients with pectus carinatum, arcuatum, or mixed deformities were excluded from this study. RESULTS A total of 94 patients met inclusion criteria. Of these, 82% were male, with a median age of 15 y. Patients were further subdivided by BMI, with 46% of patients having a BMI of <18.5 kg/m2 (i.e., underweight), whereas 54% of patients had a BMI of ≥18.5 kg/m2. Using a threshold PED of 2 cm, patients with a BMI of <18.5 kg/m2 had correct classification rates of 93% and 95% using PED relative to HI and CI, respectively. Patients with a BMI of ≥18.5 kg/m2 had correct classification rates of 80% and 88% using PED relative to HI and CI, respectively, at the same 2 cm threshold. CONCLUSIONS PED is a viable screening tool for the preoperative evaluation of PE with a 2 cm threshold providing the combination of high sensitivity, specificity, and correct classification rates especially in underweight patients.
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Hedén P, Sinna R. An Open, Prospective Study to Evaluate the Effectiveness and Safety of Hyaluronic Acid for Pectus Excavatum Treatment. Aesthet Surg J 2019; 39:NP189-NP201. [PMID: 30388191 PMCID: PMC6520969 DOI: 10.1093/asj/sjy303] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Background Pectus excavatum (PE) is sometimes associated with psychological and physiological difficulties influencing a patient’s quality of life. Treatment with a hyaluronic acid (HA)-based gel may benefit patients and be an alternative to other more invasive treatments. Objectives The authors sought to evaluate the effectiveness in terms of satisfaction, duration, and safety of HA gel treatment for PE including impact on quality of life. Methods Males ≥18 years having PE without functional problems received HA gel injections (50 – 150 mL) at the site of deformity and in some cases at the medial pectoralis muscle borders to optimize the aesthetic result. Follow-up visits were performed after 1, 3, 6, 12, and 24 months with optional retreatment at the 24-month visit including a 1-month follow-up. Evaluations included Pectus Excavatum Evaluation Questionnaire, patient satisfaction, magnetic resonance imaging, and safety assessments. Results The treatment significantly improved patients’ self-esteem (P < 0.001) and psychosocial function (P ≤ 0.038) throughout the study, as assessed by Pectus Excavatum Evaluation Questionnaire. Patients were satisfied with the aesthetic outcome and considered the treatment mild in terms of level of pain during injection. Treatment effects were maintained up to 24 months and 58% of the HA gel remained at this visit, shown by Magnetic Resonance Imaging measurements. The treatment was well tolerated. Conclusions Treatment of PE with HA gel improved patient quality of life related to self-esteem and psychosocial functioning including aesthetically pleasing results. The treatment may also offer benefits in terms of safety and tolerability compared with other treatments. Level of Evidence: 4
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Affiliation(s)
| | - Raphael Sinna
- Department of Plastic Reconstructive and Aesthetic Surgery, University Hospital Amiens, Amiens, France
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A Novel Objective Approach to the External Measurement of Pectus Excavatum Severity by Means of an Optical Device. Ann Thorac Surg 2018; 106:221-227. [DOI: 10.1016/j.athoracsur.2018.02.024] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Revised: 02/07/2018] [Accepted: 02/12/2018] [Indexed: 11/24/2022]
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A New modified anthropometric haller index obtained without radiological exposure. Int J Cardiovasc Imaging 2018; 34:1505-1509. [DOI: 10.1007/s10554-018-1366-5] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/02/2018] [Accepted: 05/09/2018] [Indexed: 10/16/2022]
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Impact of Pectus Excavatum on Cardiopulmonary Function. Ann Thorac Surg 2018; 105:455-460. [DOI: 10.1016/j.athoracsur.2017.09.037] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2017] [Revised: 09/11/2017] [Accepted: 09/18/2017] [Indexed: 11/23/2022]
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Abid I, Ewais MM, Marranca J, Jaroszewski DE. Pectus Excavatum: A Review of Diagnosis and Current Treatment Options. J Osteopath Med 2017; 117:106-113. [PMID: 28134952 DOI: 10.7556/jaoa.2017.021] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Osteopathic medicine places a special emphasis on the musculoskeletal system, and understanding how chest wall structure may influence function is critical. Pectus excavatum is a common congenital chest wall defect in which the sternum is depressed posteriorly. Patients may present with complaints of chest wall discomfort, exercise intolerance, and tachycardia. The medical implications, diagnosis, and treatment options for patients with pectus excavatum are reviewed.
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Seddon P. Options for assessing and measuring chest wall motion. Paediatr Respir Rev 2015; 16:3-10. [PMID: 25468220 DOI: 10.1016/j.prrv.2014.10.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Accepted: 10/22/2014] [Indexed: 11/16/2022]
Abstract
Assessing chest wall motion is a basic and vital component in managing the child with respiratory problems, whether these are due to pathology in the lungs, airways, chest wall or muscles. Since the 1960s, clinical assessment has been supplemented with an ever-growing range of technological options for measuring chest wall motion, each with unique advantages and disadvantages. Measurements of chest wall motion can be used to: (1) Assess respiratory airflow and volume change, as a non-invasive alternative to measurement at the airway opening, (2) Monitor breathing over long periods of time, to identify apnoea and other types of sleep-disordered breathing, (3)Identify and quantify patterns of abnormal chest wall movement, whether between ribcage and abdominal components (thoracoabdominal asynchrony) or between different regions of the ribcage (eg in scoliosis and pectus excavatum). Measuring chest wall motion allows us to do things which simply cannot be done by more mainstream respiratory function techniques measuring flow at the airway opening: it allows respiratory airflow to be measured when it would otherwise be impossible, and it tells us how the different parts of the chest wall (eg ribcage vs abdomen, right vs left) are moving in order to generate that airflow. The basis of the different techniques available to assess and measure chest wall motion will be reviewed and compared, and their relevance to paediatric respiratory practice assessed.
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Affiliation(s)
- Paul Seddon
- Consultant Respiratory Paediatrician, Royal Alexandra Children's Hospital, Eastern Road, Brighton BN2 5BE, United Kingdom.
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Morphologic assessment of thoracic deformities for the preoperative evaluation of pectus excavatum by magnetic resonance imaging. Eur Radiol 2014; 25:785-91. [DOI: 10.1007/s00330-014-3450-0] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2014] [Revised: 07/25/2014] [Accepted: 09/22/2014] [Indexed: 11/29/2022]
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Sarwar ZU, DeFlorio R, O׳Connor SC. Pectus Excavatum: Current Imaging Techniques and Opportunities for Dose Reduction. Semin Ultrasound CT MR 2014; 35:374-81. [DOI: 10.1053/j.sult.2014.05.003] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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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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Abaci O, Cetinkal G, Kocas C, Evren E, Yildiz M, Yildizeli B, Yanartaş M. Pulmonary embolism: a late complication of pectus excavatum repair. CONGENIT HEART DIS 2013; 9:E113-5. [PMID: 23721082 DOI: 10.1111/chd.12094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/06/2013] [Indexed: 11/30/2022]
Abstract
The Ravitch operation is frequently performed to correct pectus excavatum with few and minor complications. We present a case of pulmonary embolism with pulmonary endarterectomy in a patient undergoing Ravitch repair for pectus excavatum 2 years ago.
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Affiliation(s)
- Okay Abaci
- Department of Cardiology, Istanbul University Cardiology Institute
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15
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Reply. AJR Am J Roentgenol 2012. [DOI: 10.2214/ajr.12.9183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Limited, Fast Magnetic Resonance Imaging as an Alternative for Preoperative Evaluation of Pectus Excavatum. J Thorac Imaging 2012; 27:393-7. [DOI: 10.1097/rti.0b013e31822da1b6] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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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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Lo Piccolo R, Bongini U, Basile M, Savelli S, Morelli C, Cerra C, Spinelli C, Messineo A. Chest fast MRI: an imaging alternative on pre-operative evaluation of Pectus Excavatum. J Pediatr Surg 2012; 47:485-9. [PMID: 22424342 DOI: 10.1016/j.jpedsurg.2011.09.038] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2010] [Revised: 08/12/2011] [Accepted: 09/01/2011] [Indexed: 10/28/2022]
Abstract
BACKGROUND Standard imaging methods in evaluating chest wall deformities, such as Pectus Excavatum (PE) in paediatric and adolescent patients, include baseline 2-view chest radiography and chest CT scan. Only few studies to date investigated the value of fast MRIin the pre operative assessment of patient affected by PE. OBJECTIVE To evaluate the efficacy of chest fast MRI in pre-operative management of patient affected by PE. To obtain the Haller Index (HI) and Asymmetry Index (AI) from chest fast MRI protecting patients from radiation exposure. MATERIALS AND METHODS We analyzed the data of 42 consecutive patients with severe PE who underwent minimally invasive repair between March 2007 and March 2010. All 42 patients received chest fast MRI, but only the first 5 in view of the results, were studied also with chest ultrafast CT scan. In both examinations, data at the deepest point of the depression were collected. RESULTS Severity indices of the deformity using HI and AI, collected from CT scan and fast MRI in the first 5 patients, were comparable. In the remaining 37 fast chest MRI offered good images of the chest wall deformities with no radiation exposure, detailing anatomical information such as displacement and rotation of the heart or great vessels anomalies. CONCLUSION This study suggests the use of chest MRI in pre operative workup for patients with PE to obtain severity indices (Haller Index and Asymmetry Index avoiding radiation exposure to paediatric patients.
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Affiliation(s)
- Roberto Lo Piccolo
- Department of Pediatric Surgery, Anna Meyer Children's Hospital, 50100 Florence, Italy.
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Breathe In... Breathe Out... Stop Breathing: Does Phase of Respiration Affect the Haller Index in Patients With Pectus Excavatum? AJR Am J Roentgenol 2011; 197:W934-9. [DOI: 10.2214/ajr.11.6430] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Abstract
Pectus excavatum, the most common congenital deformity of the anterior chest wall, is both a cosmetic and functional abnormality. The degree of abnormal chest wall deformity determines its functional effect, particularly its cardiac and pulmonary impact. Although CT scanning is the most widely used cross-sectional imaging technique used to measure the Haller index, the radiation exposure is reason to seek other alternatives. At our institution, we have introduced a rapid MRI technique for this purpose, which utilizes a single-axial 2-D FIESTA acquisition.
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Correlation between sternal depression and cardiac rotation in pectus excavatum: Evaluation with helical CT. AJR Am J Roentgenol 2010; 195:W76-80. [PMID: 20566785 DOI: 10.2214/ajr.09.3199] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate the effect of the degree of sternal depression on the cardiac rotation of pectus excavatum as depicted with helical CT. MATERIALS AND METHODS Sixty-three patients (53 boys, 10 girls; mean age, 9.7 +/- 7 years) with pectus excavatum who underwent helical chest CT and surgical correction were included in this study. Depth of sternal depression, CT depression index, cardiac rotation angle, and pulmonary vein angle were measured, and the correlation of these parameters was analyzed. RESULTS The mean sternal depression was 21 +/- 7 mm; CT depression index, 2.7 +/- 1.4; cardiac rotation angle, 55 degrees +/- 9 degrees ; and pulmonary vein angle, 52 degrees +/- 12 degrees . The sternal depression (18 mm) in patients with a CT depression index less than 2.4 was less than that in patients with a CT depression index of 2.4-2.9 (sternal depression, 21 mm) or greater than 2.9 (sternal depression, 28 mm) (p < 0.01). Similarly, the cardiac rotation angle (49 degrees +/- 5 degrees ) in patients with a CT depression index less than 2.4 was smaller than that in patients with a CT depression index of 2.4-2.9 (55 degrees +/- 6 degrees ) or greater than 2.9 (64 degrees +/- 12 degrees ) (p < 0.01). The pulmonary vein angle in patients with a CT depression index less than 2.4 (59 degrees +/- 11 degrees ) was larger than that in patients with a CT depression index of 2.4-2.9 (50 degrees +/- 12 degrees ) or a CT depression index greater than 2.9 (45 degrees +/- 8 degrees ) (p < 0.01). Cardiac rotation angle had a positive correlation with CT depression index (r = 0.75, p < 0.01). CONCLUSION The degree of sternal depression has a positive correlation with the degree of cardiac rotation in pectus excavatum. Helical CT is a valuable technique for evaluating the chest deformity and resultant cardiac rotation.
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Park SY, Park TH, Kim JH, Baek HK, Seo JM, Kim WJ, Nam YH, Cha KS, Kim MH, Kim YD. A case of right ventricular dysfunction caused by pectus excavatum. J Cardiovasc Ultrasound 2010; 18:62-5. [PMID: 20706572 DOI: 10.4250/jcu.2010.18.2.62] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2010] [Revised: 03/30/2010] [Accepted: 05/18/2010] [Indexed: 01/31/2023] Open
Abstract
Pectus excavatum compresses the underlying right side of the heart, which might lead to right ventricular dysfunction as illustrated in this case report.
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Affiliation(s)
- Sun-Yi Park
- Department of Cardiology, Dong-A University College of Medicine, Busan, Korea
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Pathology of the thoracic wall: congenital and acquired. Pediatr Radiol 2010; 40:859-68. [PMID: 20432004 DOI: 10.1007/s00247-010-1604-z] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2009] [Accepted: 01/24/2010] [Indexed: 10/19/2022]
Abstract
This review aims to cover the main congenital and acquired lesions that arise in the thoracic wall of infants and children. Imaging often plays an essential role in the evaluation of symptomatic and asymptomatic thoracic wall abnormalities. The use of appropriate imaging modalities for each condition will be addressed, as well as the range of benign and malignant conditions that can occur.
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White JA, Fine NM, Shargall Y. Images in cardiovascular medicine. Pectus excavatum with compression of the inferior vena cava: a rare cause of recurrent syncope. Circulation 2009; 120:1722-4. [PMID: 19858425 DOI: 10.1161/circulationaha.109.866400] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- James A White
- Department of Medicine, London Health Sciences Centre, London, Ontario, Canada.
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Herrmann KA, Zech C, Strauss T, Hatz R, Schoenberg S, Reiser M. CINE-MRT des Thorax bei Patienten mit Pectus excavatum. Radiologe 2006; 46:309-16. [PMID: 16550355 DOI: 10.1007/s00117-006-1354-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
BACKGROUND Morphologic and dynamic assessment of respiratory chest kinetics was performed in patients with pectus excavatum deformity (PE) using dynamic MRI: cine MRI. MATERIAL AND METHODS Seven consecutive patients with PE (aged 20.3 years+/-4.0) and ten healthy volunteers of comparable age underwent real-time cine MRI of the chest during breathing on a 1.5 T MR scanner (Magnetom Sonata, Siemens Medical Systems, Erlangen, Germany) using a standard phased array body coil and a half-Fourier single-shot turbo spin echo sequence (HASTE) for dynamic imaging. During deep inspiration and expiration, single-shot sequences were performed in one slice level over 20 s at a frequency of 1 image/s covering the entire thoracic cage in three orientations. Morphology and chest kinetics in patients with PE were analyzed and compared with normal values, and typical patterns of chest kinetics were noted. RESULTS Three different types of chest morphology in PE were identified: (1) the generally flattened thoracic cage, (2) the "tilted" sternum, and (3) the focally deepened sternum. Three patterns of motion correspond to these morphological types: (1) elevation of the sternum and the anterior thoracic wall, (2) angulated elevation of the parasternal rib cage with persistent deepening of the sternum resembling a "wing beat" movement, and (3) increased diaphragmatic movements with limited chest wall dynamics. CONCLUSIONS Cine MRI is an adequate radiation-free diagnostic modality for the dynamic imaging of both chest morphology and chest wall kinetics in patients with PE. The pectus severity index can easily be determined and three typical movement patterns of chest wall kinetics identified.
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Affiliation(s)
- K A Herrmann
- Institut für Klinische Radiologie, Klinikum Grosshadern der Ludwig-Maximilians-Universität, Marchioninistr. 15, 81377 , München.
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Yalamanchili K, Summer W, Valentine V. Pectus excavatum with inspiratory inferior vena cava compression: a new presentation of pulsus paradoxus. Am J Med Sci 2005; 329:45-7. [PMID: 15654179 DOI: 10.1097/00000441-200501000-00008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
A 29-year-old man with pectus excavatum presented with exercise intolerance, pulsus paradoxus, and paradoxically split S2. Chest computed tomography (CT) showed the heart shifted leftward and a pectus severity index of 7.18. Cardiopulmonary exercise study showed reduced VO2max, anaerobic threshold, and oxygen pulse. Echocardiography revealed a decline in mitral and tricuspid valve inflow, and stroke volume during inspiration. Cardiac extrinsic compression and anatomic cardiac abnormalities were not present. Dynamic magnetic resonance imaging (MRI) demonstrated inspiratory inferior vena cava (IVC) compression at the diaphragm. We discuss IVC compression by the diaphragm as a source of patient symptoms and as a mechanism for pulsus paradoxus associated with pectus excavatum.
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Affiliation(s)
- Kishore Yalamanchili
- Division of Pulmonary and Critical Care, Louisiana State University Health Science Center, New Orleans, Louisiana 70112, USA.
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Plathow C, Ley S, Fink C, Puderbach M, Heilmann M, Zuna I, Kauczor HU. Evaluation of Chest Motion and Volumetry During the Breathing Cycle by Dynamic MRI in Healthy Subjects. Invest Radiol 2004; 39:202-9. [PMID: 15021323 DOI: 10.1097/01.rli.0000113795.93565.c3] [Citation(s) in RCA: 66] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
RATIONALE AND OBJECTIVES To investigate diaphragm and chest wall motion during the whole breathing cycle using magnetic resonance imaging (MRI) and a volumetric model in correlation with spirometry. MATERIALS AND METHODS Breathing cycles of 15 healthy volunteers were examined using a trueFISP sequence (5 slices in 3 planes, 3 images per second). Time-distance curves were calculated and correlated to spirometry. A model for vital capacity (VC), continuous time-dependent vital capacity (tVC), and investigating the influence of horizontal and vertical parameters on tVC was introduced. RESULTS Time-distance curves of the breathing cycle using MRI correlated highly significant with spirometry (P < 0.0001). VC calculated by the model was similar to VC measured in spirometry (5.00 L vs. 5.15 L). tVC correlated highly significantly with spirometry (P < 0.0001). Vertical parameters had a more profound influence on tVC change than horizontal parameters. CONCLUSIONS Dynamic MRI is a simple noninvasive method to evaluate local chest wall motion and respiratory mechanics. It widens the repertoire of tools for lung examination with a high temporal resolution.
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Affiliation(s)
- Christian Plathow
- Department of Radiology, Therapy, German Cancer Research Center Heidelberg, Heidelberg, Germany.
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