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Acipayam A, Güllü UU, Güngör Ş. Cardiac anomalies in pediatric patients with pectus excavatum. REVISTA DA ASSOCIACAO MEDICA BRASILEIRA (1992) 2023; 69:e20221301. [PMID: 37466586 DOI: 10.1590/1806-9282.20221301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Accepted: 04/28/2023] [Indexed: 07/20/2023]
Abstract
OBJECTIVE Pectus excavatum is the most prevalently encountered deformity of the thoracic wall. It can be accompanied by congenital anomalies. METHODS The cardiac findings of 36 children who were diagnosed at the Thoracic surgery outpatient clinic of our university between 10 February 2021 and 1 October 2021 and 57 healthy children in a similar age group were analyzed. RESULTS We determined that the pectus excavatum patients in our study had a higher risk of having mitral insufficiency, mitral valve prolapse, tricuspid valve prolapse, cardiac malposition, and congenital heart disease. CONCLUSION Our study showed that the prevalence of cardiac pathologies was higher in pediatric pectus excavatum patients than in healthy children in the control group. Thus, we recommend clinicians to refer pediatric pectus excavatum patients to pediatric cardiology outpatient clinics for the early diagnosis of potential cardiac pathologies.
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Affiliation(s)
- Ahmet Acipayam
- Kahramanmaraş Sütçü İmam University, Faculty of Medicine, Department of Thoracic Surgery - Kahramanmaras, Turkey
| | - Utku Ufuk Güllü
- Hatay Mustafa Kemal University, Faculty of Medicine, Department of Pediatric Cardiology - Antakya, Turkey
| | - Şükrü Güngör
- Kahramanmaraş Sütçü İmam University, Faculty of Medicine, Department of Pediatric Gastroenterology, Hepatology and Nutrition - Kahramanmaras, Turkey
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David VL. Current Concepts in the Etiology and Pathogenesis of Pectus Excavatum in Humans-A Systematic Review. J Clin Med 2022; 11:jcm11051241. [PMID: 35268332 PMCID: PMC8911421 DOI: 10.3390/jcm11051241] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2022] [Revised: 02/16/2022] [Accepted: 02/21/2022] [Indexed: 01/16/2023] Open
Abstract
Pectus excavatum (PE) is the most common deformity of the chest wall and is characterized by the posterior depression of the sternum and the lower costal cartilages. To date, the etiology of PE in humans remains enigmatic. Several etiologic hypotheses have been proposed over the past two centuries. However, most of them have been scientifically dismissed and now have only historic value. In this systematic review, we assess scientific publications of the past two centuries addressing the issue of the origin of PE in humans. We present and discuss the histologic, genetic, biomechanical, and experimental scientific achievements that contributed to the clarification of its etiology and pathogenesis. With no clear consensus over the exact mechanism, most recent studies agree that the primordial defect leading the deformation of the anterior chest wall in PE is related to the costal hyaline cartilage structure and function. Further studies on this subject must be carried out. Genetic studies seem to be the most promising way to understand the exact mechanism of PE's origin and pathogenesis.
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Affiliation(s)
- Vlad Laurentiu David
- Department of Pediatric Surgery and Orthopedics, "Victor Babes" University of Medicine and Pharmacy, 2 Eftimie Murgu, 300041 Timisoara, Romania
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David V, Stanciulescu M, Horhat F, Sharma A, Kundnani N, Ciornei B, Stroescu R, Popoiu M, Boia E. Costal cartilage overgrowth does not induce pectus‑like deformation in the chest wall of a rat model. Exp Ther Med 2021; 23:146. [PMID: 35069827 PMCID: PMC8756389 DOI: 10.3892/etm.2021.11069] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Accepted: 12/01/2021] [Indexed: 11/16/2022] Open
Abstract
Overgrowth of the costal cartilages has been frequently reported to be an etiological factor of chest wall deformities in children. The present study aimed to investigate if induced overgrowth of the costal cartilages could lead to deformation of the chest wall in a rat model. An insulin-like growth factor 1 (IGF1) solution was directly injected under the perichondrium of the last three costal cartilages of 2-week-old rat pups. Two different concentrations, 50 µg/ml (E50) and 100 µg/ml (E100), were applied. This procedure was repeated once per week for 5 consecutive weeks. Subsequently, 14 days after the last injection, all animals were euthanized before the shape of the thoracic cage was assessed, and the diameter was measured. In addition, the last three costal cartilages were dissected before the samples were prepared and examined by light microscopy. Rats that received E100 exhibited larger sagittal and coronal rib cage diameters compared with those in the E50 and control groups. However, no deformation could be observed in the chest wall. Microscopic examinations revealed an anabolic pattern in the E100 group. The present findings suggested that locally administered IGF1 stimulated cell proliferation and tissue growth in coastal cartilages in a dose-dependent manner in vivo. However, this induced overgrowth of the costal cartilages did not result in the deformation of the chest wall.
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Affiliation(s)
- Vlad David
- Department of Pediatric Surgery and Orthopedics, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Maria Stanciulescu
- Department of Pediatric Surgery and Orthopedics, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Florin Horhat
- Department of Microbiology, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Abhinav Sharma
- Department of Cardiovascular Rehabilitation, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Nilima Kundnani
- Department of Functional Sciences, Physiology, Centre of Immuno‑Physiology and Biotechnologies (CIFBIOTEH), ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Bogdan Ciornei
- Department of Pediatric Surgery and Orthopedics, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Ramona Stroescu
- Department of Pediatrics, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Marius Popoiu
- Department of Pediatric Surgery and Orthopedics, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
| | - Eugen Boia
- Department of Pediatric Surgery and Orthopedics, ‘Victor Babes’ University of Medicine and Pharmacy, 300041 Timisoara, Romania
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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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Rat Animal Model of Pectus Excavatum. Life (Basel) 2020; 10:life10060096. [PMID: 32604800 PMCID: PMC7345094 DOI: 10.3390/life10060096] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Revised: 06/16/2020] [Accepted: 06/24/2020] [Indexed: 01/20/2023] Open
Abstract
Background: pectus excavatum (PE) is the most common congenital deformity of the thoracic wall. Lately, significant achievements have been made in finding new, less invasive treatment methods for PE. However, most of the experimental work was carried out without the help of an animal model. In this report we describe a method to create an animal model for PE in Sprague-Dawley rats. Methods: We selected 15 Sprague-Dawley rat pups and divided them into two groups: 10 for the experimental group (EG) and 5 for the control group (CG). We surgically resected the last four pairs of costal cartilages in rats from the EG. The animals were assessed by CT-scan prior to surgery and weekly for four consecutive weeks. After four weeks, the animals were euthanized and the thoracic cage was dissected from the surrounding tissue. Results: On the first postoperative CT, seven days after surgery, we observed a marked depression of the lower sternum in all animals from the EG. This deformity was present at every CT-scan after surgery and at the post-euthanasia assessment. Conclusions: By decreasing the structural strength of the lower costal cartilages, we produced a PE animal model in Sprague-Dawley rats.
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