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Sonaglioni A, Nicolosi GL, Trevisan R, Lombardo M, Grasso E, Gensini GF, Ambrosio G. The influence of pectus excavatum on cardiac kinetics and function in otherwise healthy individuals: A systematic review. Int J Cardiol 2023; 381:135-144. [PMID: 37003372 DOI: 10.1016/j.ijcard.2023.03.058] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Revised: 02/28/2023] [Accepted: 03/27/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND A number of anterior chest wall deformities, most notably pectus excavatum (PE), may have a detrimental effect on cardiac motion and function. Interpretation of transthoracic echocardiography (TTE) and speckle-tracking echocardiography (STE) results may be hampered by the possible influence of PE on cardiac kinetics. METHODS A comprehensive search of all articles assessing cardiac function in PE individuals was carried out. Inclusion criteria were: 1) individuals aged >10 years; 2) studies providing objective assessment of chest deformity (Haller index). Studies that measured myocardial strain parameters in PE patients were also included. RESULTS The search (EMBASE and Medline) yielded a total of 392 studies, 36 (9.2%) of which removed as duplicates; a further 339 did not meet inclusion criteria. The full-texts of 17 studies were then analyzed. All studies concordantly reported impaired right ventricular volumes and function. With respect to left ventricle (LV), TTE studies uniformly demonstrated a significant impairment in conventional echoDoppler indices in PE individuals, whereas STE studies provided conflicting results. Importantly, LV functional alterations promptly reverted upon surgical correction of chest defect. In subjects with PE of mild-to-moderate severity, we observed that degree of anterior chest wall deformity, as noninvasively assessed by modified Haller index (MHI), was strongly associated with myocardial strain magnitude, in heterogenous cohorts of otherwise healthy PE individuals. CONCLUSIONS Clinicians should be aware that in PE individuals, TTE and STE results may not always be indicative of intrinsic myocardial dysfunction, but may be, at least in part, influenced by artifactual and/or external chest shape determinants.
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Affiliation(s)
| | | | | | | | - Enzo Grasso
- Division of Cardiology, MultiMedica IRCCS, Milan, Italy
| | | | - Giuseppe Ambrosio
- Cardiology and Cardiovascular Pathophysiology, Azienda Ospedaliero-Universitaria "S. Maria Della Misericordia", Perugia, Italy
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Tilliet Le Dentu H, Lancien U, Sellal O, Duteille F, Perrot P. [Contribution of computer-aided design for the conception of custom-made implants in Pectus Excavatum surgical treatment. Experience of the Nantes plastic surgery unit]. ANN CHIR PLAST ESTH 2017; 63:1-10. [PMID: 29246660 DOI: 10.1016/j.anplas.2017.11.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Accepted: 11/15/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Pectus excavatum is the most common congenital chest malformation and is a common reason for consultation in plastic surgery. Our attitude is most often a filling of the depression with a custom-made silicone prosthesis. The objective of this work was to evaluate the interest of computer-aided design (CAD) of implants compared to the conventional plaster molds method. PATIENTS AND METHODS We have collected all the cases of custom-made silicone implants to treat funnel chests in our plastic surgery department. The quality of the results was evaluated by the patient, and in a blind manner by the surgical team using photographs and standardized surveys. The pre-operative delays, the operating time and length of hospital stays, the number of surgical recoveries, and the post-operative surgical outcomes were recorded. RESULTS Between 1990 and 2016, we designed 29 silicone thoracic implants in our department. Before 2012, implants were made from plaster chest molds (n=13). After this date, implants were designed by CAD (n=16). Patients rated their results as "good" or "excellent" in 77% and 86% of cases respectively in the plaster and CAD groups. The surgical team's ratings for CAD implant reconstructions were better than in the plaster group: 8.17 versus 6.96 (P=0.001). CAD implants were significantly less detectable than the plaster group implants. The operating time was reduced in the CAO group: 60.2 compared to 74.7minutes in the plaster group (P=0.04), as was the length of hospitalization: 3.5 versus 5.3 days (P=0.01). There were no significant differences between the two groups in terms of post-operative complications. CONCLUSION The management of pectus excavatum by a custom-made silicone implant is a minimally invasive method that provides good cosmetic results. The design of these implants is facilitated and qualitatively improved by CAD.
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Affiliation(s)
- H Tilliet Le Dentu
- Service de chirurgie plastique et reconstructrice, hôpital Hôtel-Dieu, centre des brûlés, CHU de Nantes, 44093 Nantes Cedex 01, France
| | - U Lancien
- Service de chirurgie plastique et reconstructrice, hôpital Hôtel-Dieu, centre des brûlés, CHU de Nantes, 44093 Nantes Cedex 01, France
| | - O Sellal
- Pharmacie centrale, hôpital Saint-Jacques, CHU de Nantes, 44093 Nantes Cedex 01, France
| | - F Duteille
- Service de chirurgie plastique et reconstructrice, hôpital Hôtel-Dieu, centre des brûlés, CHU de Nantes, 44093 Nantes Cedex 01, France
| | - P Perrot
- Service de chirurgie plastique et reconstructrice, hôpital Hôtel-Dieu, centre des brûlés, CHU de Nantes, 44093 Nantes Cedex 01, France.
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Abstract
The correction of deep pectus excavatum, with the Nuss procedure, frequently require a series of maneuvers that is inherently dangerous. Herein we describe 10 technical modifications to prevent potential complications. These modified techniques have certain advantages and according to the authors, with these maneuvers the risk of pericardial sac, cardiac injury, bar displacement and complications during the removal of the bar could be markedly reduced.
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Affiliation(s)
| | - Miguel Lia Tedde
- Hospital das Clinicas, University of São Paulo, Hospital Israelita Albert Einstein, São Paulo, Brazil
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Kabbaj R, Burnier M, Kohler R, Loucheur N, Dubois R, Jouve JL. Minimally invasive repair of pectus excavatum using the Nuss technique in children and adolescents: indications, outcomes, and limitations. Orthop Traumatol Surg Res 2014; 100:625-30. [PMID: 25199962 DOI: 10.1016/j.otsr.2014.05.019] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2012] [Revised: 05/07/2014] [Accepted: 05/23/2014] [Indexed: 02/02/2023]
Abstract
BACKGROUND Pectus excavatum (PE) is a common congenital deformity. The Nuss technique for minimally invasive repair of PE involves thoracoscopy-assisted insertion of a bar or plate behind the deformity to displace the sternum anteriorly. Our objective here was to clarify the indications and limitations of the Nuss technique based on a review of 70 patients. MATERIALS AND METHODS A retrospective review of children managed at two centres identified 70 patients who had completed their growth and had their plate removed. Mean age was 13.8 years (range, 6-19 years). The reason for surgery was cosmetic disfigurement in 66 (95%) patients. The original Nuss technique was used in 63 patients, whereas 7 patients required an additional sub-xiphoid approach. Time to implant removal ranged from 8 months to 3 years. RESULTS The cosmetic outcome was considered satisfactory by the patients in 64 (91%) cases and by the surgeon in 60 (85.7%) cases. Major complications requiring further surgery occurred in 6 (8.5%) patients and consisted of haemothorax (n=2), chest wall sepsis (n=2, including 1 after implant removal), allergy (n=1), and implant displacement (n=1). Early or delayed minor complications occurred in 46 (65%) patients and resolved either spontaneously or after non-surgical therapy. DISCUSSION The minimal scarring and reliably good outcomes support the widespread use of the Nuss technique in children and adolescents. Our complication rates (minor, 65%; and major, 8.5%) are consistent with previous publications. In our opinion, contra-indications to thoracoscopic PE correction consist of a history of cardio-thoracic surgery and the finding by computed tomography of a sternum-to-spine distance of less than 5 cm or of sternum rotation greater than 35°. In these situations, we recommend a sub- and retro-xiphoid approach to guide implant insertion or a classic sterno-chondroplasty procedure. LEVEL OF EVIDENCE Level IV, retrospective descriptive cohort study.
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Affiliation(s)
- R Kabbaj
- Service de chirurgie orthopédique pédiatrique, hôpital d'Enfants de la Timone, AP-HM, Aix-Marseille université, rue Saint-Pierre, 13385 Marseille cedex 5, France.
| | - M Burnier
- Service de chirurgie orthopédique pédiatrique, hôpital Femme-Mère-Enfant, hospices civils de Lyon, université Lyon 1, 59, boulevard Pinel, 69677 Bron cedex, France
| | - R Kohler
- Service de chirurgie orthopédique pédiatrique, hôpital Femme-Mère-Enfant, hospices civils de Lyon, université Lyon 1, 59, boulevard Pinel, 69677 Bron cedex, France
| | - N Loucheur
- Service de chirurgie orthopédique pédiatrique, hôpital d'Enfants de la Timone, AP-HM, Aix-Marseille université, rue Saint-Pierre, 13385 Marseille cedex 5, France
| | - R Dubois
- Service de chirurgie thoracique pédiatrique, hôpital Femme-Mère-Enfant, hospices civils de Lyon, université Lyon 1, 59, boulevard Pinel, 69677 Bron cedex, France
| | - J-L Jouve
- Service de chirurgie orthopédique pédiatrique, hôpital d'Enfants de la Timone, AP-HM, Aix-Marseille université, rue Saint-Pierre, 13385 Marseille cedex 5, France
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Rebeis EB, Campos JRMD, Moreira LFP, Pastorino AC, Pêgo-Fernandes PM, Jatene FB. Variation of the Anthropometric Index for pectus excavatum relative to age, race, and sex. Clinics (Sao Paulo) 2013; 68:1215-9. [PMID: 24141837 PMCID: PMC3782722 DOI: 10.6061/clinics/2013(09)07] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Accepted: 04/22/2013] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES To determine possible variations in the Anthropometric Index for pectus excavatum relative to age, race, and sex in individuals free of thoracic wall deformities. METHODS Between 2002 and 2012, 166 individuals with morphologically normal thoracic walls consented to have their chests and the perimeter of the lower third of the thorax measured according to the Anthropometric Index for pectus excavatum. The participant characteristics are presented (114 men and 52 women; 118 Caucasians and 48 people of African descent). RESULTS Measurements of the Anthropometric Index for pectus excavatum were statistically significantly different between men and women (11-40 years old); however, no significant difference was found between Caucasians and people of African descent. For men, the index measurements were not significantly different across all of the age groups. For women, the index measurements were significantly lower for individuals aged 3 to 10 years old than for individuals aged 11 to 20 years old and 21 to 40 years old; however, no such difference was observed between women aged 11 to 20 years old and those aged 21 to 40 years old. CONCLUSION In the sample, significant differences were observed between women aged 11 to 40 years old and the other age groups; however, there was no difference between Caucasian and people of African descent.
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Affiliation(s)
- Eduardo Baldassari Rebeis
- Instituto do Coração, Faculdade de Medicina, Hospital das Clínicas, Universidade de São Paulo, São PauloSP, Brazil
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Zampieri N, Ruggeri G, Scirè G, Gargano T, Camoglio SF, Lima M. The role of transthoracic ultrasounds to assess patients with pectus excavatum. J Pediatr Surg 2013; 48:496-501. [PMID: 23480902 DOI: 10.1016/j.jpedsurg.2012.07.062] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 07/25/2012] [Accepted: 07/27/2012] [Indexed: 10/27/2022]
Abstract
INTRODUCTION Pectus excavatum is the most common congenital malformation of the anterior chest wall. The purpose of this study is to assess the role of thoracic ultrasound studies in the preoperative workup of patients affected by pectus excavatum and to identify the dynamics of the chest wall. MATERIALS AND METHODS An observational study was carried out between January and September 2011. Patients between 4 and 14 years of age were divided into 5 study groups. Group A: healthy patients without pectus excavatum; Group B: healthy patients with different grades of untreated pectus excavatum; Group C: patients with pectus excavatum treated with a Nuss bar; Group D: patients surgically treated with removed bar; Group E: patients surgically treated with different techniques. RESULTS Patients with deeper anatomical depression showed a differential value between maximum inspiration and forced expiration lower than healthy patients or patients with shallower depression (p<0.05) in any age range considered. A depression deeper than 2.8 cm was associated with lower elasticity of the chest wall. CONCLUSIONS Study results demonstrate that the ultrasound is useful in patients with PE. Patients with pectus excavatum have altered chest dynamics when compared to healthy patients. The study also demonstrate that between the 4th and the 6th ribs there is the great dynamicity of the chest wall.
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Affiliation(s)
- Nicola Zampieri
- Department of Surgical Sciences, Pediatric Surgical Unit, University of Verona, Policlinico G.B.Rossi, Piazzale Scuro n. 1-Verona, Italy.
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Angstman KB, Myszkowski MR. Pectus excavatum: review of therapeutic measures and case presentation. Clin Pediatr (Phila) 2010; 49:889-92. [PMID: 20356916 DOI: 10.1177/0009922810364659] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Chang PY, Chang CH, Lai JY, Chen JC, Perng DB, Zeng Q. Analysis of changes to the anterior chest wall after the Nuss procedure-an objective measurement of pectus excavatum. J Pediatr Surg 2009; 44:2291-5. [PMID: 20006012 DOI: 10.1016/j.jpedsurg.2009.07.053] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2009] [Accepted: 07/31/2009] [Indexed: 11/29/2022]
Abstract
INTRODUCTION We report a noninvasive method for recording the deviation of the anterior chest wall (ACW) in patients with pectus excavatum before and after the insertion and removal of a Nuss bar. PATIENTS AND METHOD All patients undergoing the Nuss procedure at our institutions between June 2008 and February 2009 were enrolled in this study. A thermal plastic strip was used to cast the ACW at the skin level along the area corresponding to the tract of the inserted bar. The height of the ACW was defined as the perpendicular length from the xiphoid process to the transverse line drawn between the 2 midaxillary points. RESULTS Bar insertion caused a significant increase in ACW height and width. Bar removal reduced the corrective effects in terms of a significant decrease in ACW height; at the same time, an increase in ACW width was noted. CONCLUSION Feature extraction and analyses of permanent contour casts of the ACW help to understand immediate changes in the ACW after the Nuss procedure and may assist in the design of the bar at insertion. The Nuss bar in situ helped to maintain cosmetic benefits to the ACW.
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Affiliation(s)
- Pei-Yeh Chang
- Department of Surgery, Chang Gung Memorial Hospital, Chang-Gung University, Taoyuan, Taiwan
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Glinkowski W, Sitnik R, Witkowski M, Kocoń H, Bolewicki P, Górecki A. Method of pectus excavatum measurement based on structured light technique. JOURNAL OF BIOMEDICAL OPTICS 2009; 14:044041. [PMID: 19725752 DOI: 10.1117/1.3210782] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
We present an automatic method for assessment of pectus excavatum severity based on an optical 3-D markerless shape measurement. A four-directional measurement system based on a structured light projection method is built to capture the shape of the body surface of the patients. The system setup is described and typical measurement parameters are given. The automated data analysis path is explained. Their main steps are: normalization of trunk model orientation, cutting the model into slices, analysis of each slice shape, selecting the proper slice for the assessment of pectus excavatum of the patient, and calculating its shape parameter. We develop a new shape parameter (I(3ds)) that shows high correlation with the computed tomography (CT) Haller index widely used for assessment of pectus excavatum. Clinical results and the evaluation of developed indexes are presented.
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Affiliation(s)
- Wojciech Glinkowski
- Medical University of Warsaw, Department of Orthopaedics and Traumatology of Locomotor System, Center of Excellence TeleOrto, ul. Lindleya 4, 02-005 Warsaw, Poland
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