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Journal of Electrocardiology 2024Pectus excavatum (PEx) can cause cardiopulmonary limitations due to cardiac compression and displacement. There is limited data on electrocardiogram (ECG) alterations...
BACKGROUND
Pectus excavatum (PEx) can cause cardiopulmonary limitations due to cardiac compression and displacement. There is limited data on electrocardiogram (ECG) alterations before and after PEx surgical repair, and ECG findings suggesting cardiopulmonary limitations have not been reported. The aim of this study is to explore ECG manifestations of PEx before and after surgery including associations with exercise capacity.
METHODS
A retrospective review of PEx patients who underwent primary repair was performed. ECGs before and after surgical correction were evaluated and the associations between preoperative ECG abnormalities and cardiopulmonary function were investigated.
RESULTS
In total, 310 patients were included (mean age 35.1 ± 11.6 years). Preoperative ECG findings included a predominant negative P wave morphology in V1, and this abnormal pattern significantly decreased from 86.9% to 57.4% (p < 0.001) postoperatively. The presence of abnormal P wave amplitude in lead II (>2.5 mm) significantly decreased from 7.1% to 1.6% postoperatively (p < 0.001). Right bundle branch block (RBBB) (9.4% versus 3.9%, p < 0.001), rsr' patterns (40.6% versus 12.9%, p < 0.001), and T wave inversion in leads V1-V3 (62.3% vs 37.7%, p < 0.001) were observed less frequently after surgery. Preoperative presence of RBBB (OR = 4.8; 95%CI 1.1-21.6) and T wave inversion in leads V1-3 (OR = 2.3; 95%CI 1.3-4.2) were associated with abnormal results in cardiopulmonary exercise testings.
CONCLUSION
Electrocardiographic abnormalities in PEx are frequent and can revert to normal following surgery. Preoperative RBBB and T wave inversion in leads V1-3 suggested a reduction in exercise capacity, serving as a marker for the need for further cardiovascular evaluation of these patients.
Topics: Humans; Young Adult; Adult; Middle Aged; Electrocardiography; Funnel Chest; Heart; Bundle-Branch Block; Exercise Test
PubMed: 38000149
DOI: 10.1016/j.jelectrocard.2023.11.007 -
Rozhledy V Chirurgii : Mesicnik... 2023Pectus excavatum is the most common chest wall deformity in the Czech Republic. This chest deformity is typically characterized by a wall depression with sternal... (Review)
Review
Pectus excavatum is the most common chest wall deformity in the Czech Republic. This chest deformity is typically characterized by a wall depression with sternal rotation. If the excavation of the chest wall does not cause any physical or psychological problems, the patient does not need any specific treatment. However, if the deformity is painful, affects the function of the lungs, heart or results in psychological problems, we can propose an appropriate treatment for the specific age category of the patient. Up to 10 years, we choose a procedure that includes targeted exercises and rehabilitation; in the age group of 10-15 years, we can add to the exercises the vacuum bell therapy according to the patient's wishes and compliance; and in the age category of 16 years and above, the patient can be offered a surgical solution. The Nuss operation (so-called MIRPE - minimally invasive repair of pectus excavatum) is the gold standard in surgical treatment; during this surgery, a patient-shaped bar is inserted retrosternally into the patient's chest under thoracoscopic control and is left for 3 years. The aim of this article is to describe the most common modern methods used in the treatment of patients with pectus excavatum, supplemented by a historical overview.
Topics: Adolescent; Child; Humans; Czech Republic; Funnel Chest; Minimally Invasive Surgical Procedures; Sternum; Thoracic Wall
PubMed: 38286663
DOI: 10.33699/PIS.2023.102.9.352-355 -
Current Concepts in the Etiology and Pathogenesis of Pectus Excavatum in Humans-A Systematic Review.Journal of Clinical Medicine Feb 2022Pectus 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... (Review)
Review
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.
PubMed: 35268332
DOI: 10.3390/jcm11051241 -
Zentralblatt Fur Chirurgie Feb 2022Chest wall deformities as a whole are relatively common in children and adolescents, although they comprise a wide spectrum of entities, some of them rare. Pectus... (Review)
Review
Chest wall deformities as a whole are relatively common in children and adolescents, although they comprise a wide spectrum of entities, some of them rare. Pectus excavatum has the highest prevalence. While some patients are asymptomatic, others suffer from substantial limitations. All symptomatic patients should be offered treatment. Minimally invasive surgical correction is the more effective option of treatment, besides the alternative application of a suction bell. Pectus carinatum and combined manifestations of chest wall deformities can also lead to physiological and psychosocial impairment and require treatment tailored to the individual patient in such cases. Syndromal chest wall deformities, such as Jeune syndrome, comprise a separate group of rare diseases that are associated with considerable, occasionally life-threatening comorbidities. These patients should be cared for in centres with appropriate expertise in an interdisciplinary and multimodal manner. This review discusses the different chest wall deformities encountered in paediatric surgical practice, along with their significance and possible therapeutic approaches.
Topics: Adolescent; Child; Funnel Chest; Humans; Minimally Invasive Surgical Procedures; Thoracic Wall
PubMed: 34963176
DOI: 10.1055/a-1657-0266 -
The Journal of Surgical Research Dec 2019Pectus 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... (Comparative Study)
Comparative Study
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.
Topics: Adolescent; Adult; Age Factors; Child; Databases, Factual; Female; Funnel Chest; Humans; Incidence; Length of Stay; Male; Middle Aged; Orthopedic Procedures; Patient Readmission; Postoperative Complications; Reoperation; Thoracoscopy; Time Factors; Young Adult
PubMed: 31301479
DOI: 10.1016/j.jss.2019.06.069 -
The Surgical Clinics of North America Oct 2022Pectus excavatum, carinatum, and arcuatum are 3 developmental chest wall deformities that may evolve during childhood and cause cardiac and/or pulmonary compression.... (Review)
Review
Pectus excavatum, carinatum, and arcuatum are 3 developmental chest wall deformities that may evolve during childhood and cause cardiac and/or pulmonary compression. Evaluation may include nonsurgical subspecialty consultations and imaging studies. Treatment may be nonoperative or surgical. Long-term follow-up studies have identified rare complications of traditional open repair. Routine in utero ultrasonography has led to increasing identification of congenital lung anomalies, including congenital cystic adenomatoid malformations, pulmonary sequestrations, and bronchogenic cysts. Short-term follow-up studies have suggested that some lesions may regress spontaneously. Minimally invasive techniques, including thoracoscopy, may allow for early surgical resection with less morbidity than traditional open surgery.
Topics: Cystic Adenomatoid Malformation of Lung, Congenital; Funnel Chest; Humans; Lung; Surgeons; Thoracic Wall
PubMed: 36209753
DOI: 10.1016/j.suc.2022.07.017 -
Pediatrics International : Official... 2023Pectus anomalies constitute 95% of chest anomalies. Pectus carinatum (PC) and excavatum (PE) are often asymptomatic in childhood. However, symptoms and signs such as...
BACKGROUND
Pectus anomalies constitute 95% of chest anomalies. Pectus carinatum (PC) and excavatum (PE) are often asymptomatic in childhood. However, symptoms and signs such as chest pain, dyspnea, and mitral valve prolapse (MVP) can be seen in pectus anomalies. Demographic characteristics and accompanying cardiac signs in children with pectus deformity were investigated.
METHODS
In this study, the clinical findings for children with pectus deformity, and the incidence of MVP and other concomitant heart diseases detected in echocardiographic examinations were evaluated.
RESULTS
Eighty-two children with PE, 27 with PC, and 107 healthy children were included in this study. In the echocardiographic examination of PE, PC patients, and healthy children, MVP was detected with frequencies of 25%, 33%, and 2% respectively.
CONCLUSIONS
The study showed that pectus anomalies were associated with an increased incidence of MVP. All patients with pectus deformity should therefore undergo a screening echocardiogram in adolescence to assess for the presence of MVP.
Topics: Adolescent; Humans; Child; Mitral Valve Prolapse; Thoracic Wall; Funnel Chest; Incidence; Heart
PubMed: 37518971
DOI: 10.1111/ped.15582 -
Seminars in Pediatric Surgery Feb 2024Since the 1970s, magnets have been progressively harnessed for use in minimally invasive treatment of pediatric surgical disease. In particular, multiple magnetic...
Since the 1970s, magnets have been progressively harnessed for use in minimally invasive treatment of pediatric surgical disease. In particular, multiple magnetic devices have been developed for treating esophageal atresia, pectus excavatum and scoliosis. These devices, which can be placed via small incisions or under endoscopic or fluoroscopic guidance, provide the added benefit of sparing patients multiple large, invasive procedures, and allowing for gradual correction of congenital anomalies over days to months, depending on the disease. In the following text, we detail the current landscape of magnetic devices used by pediatric surgeons, illustrate their use through clinical cases, and review the available body of literature with respect their outcomes and complications.
Topics: Child; Humans; Magnets; Funnel Chest; Endoscopy; Esophageal Atresia; Fluoroscopy; Minimally Invasive Surgical Procedures
PubMed: 38194748
DOI: 10.1016/j.sempedsurg.2024.151381 -
Journal of Pediatric Surgery Sep 2023Pectus arcuatum is often mistaken for a type of pectus carinatum. However, pectus arcuatum is a unique clinical form of pectus caused by premature obliteration of the...
BACKGROUND
Pectus arcuatum is often mistaken for a type of pectus carinatum. However, pectus arcuatum is a unique clinical form of pectus caused by premature obliteration of the sternal sutures (manubrial sternum, four sternebrae and xiphoïd process), whereas pectus carinatum is due to abnormal growth of the costal cartilage. In order to better describe pectus arcuatum, we analysed the files of patients with pectus arcuatum followed in our centers.
METHODS
Multicenter retrospective study of young patients' files diagnosed with pectus arcuatum.
RESULTS
The clinical diagnosis of pectus arcuatum was made in 34 patients with a mean age at diagnosis of 10.3 years (4-23 years). A chest profile X-ray or a CT scan was performed in 16 patients (47%) and confirmed the diagnosis of PA by the presence of a sternal fusion. It was complete in 12 patients. A malformation was associated in 35% of cases (Noonan syndrome 33%, scoliosis 25% or cardiopathy 16%). 11 patients (32%) had a family history of skeletal malformation. Orthopedic treatment was initiated in 3 patients without any success. 11 patients underwent surgical correction, which was completed in 7 of them.
CONCLUSION
The diagnosis of pectus arcuatum is based on clinical experience and if necessary, on a profile chest X-ray showing the fusion of the sternal pieces. It implies the search for any associated malformations (musculoskeletal, cardiac, syndromic). Bracing treatment is useless for pectus arcuatum. Corrective surgery, based on a sternotomy associated with a partial chondro-costal resection, can be performed at the end of growth.
LEVEL OF EVIDENCE
IV.
Topics: Humans; Child; Pectus Carinatum; Retrospective Studies; Thoracic Wall; Sternum; Musculoskeletal Abnormalities; Funnel Chest; Treatment Outcome
PubMed: 37045714
DOI: 10.1016/j.jpedsurg.2023.03.013 -
Journal of Visual Communication in... Oct 2020Conventional photography is commonly used to visually document pectus excavatum and objectively assess chest wall changes over time without repeated exposure to ionising...
Conventional photography is commonly used to visually document pectus excavatum and objectively assess chest wall changes over time without repeated exposure to ionising radiation, as in our centre since 2008. However, as conventional photography is labour-intensive and lacks three-dimensional (3D) information that is essential in 3D deformities like pectus excavatum, we developed a novel imaging and processing protocol based on 3D optical surface imaging. The objective of this study was to report our developed protocol to visually document pectus excavatum through 3D imaging. We also investigated the absolute agreement of the 3D image- and conventional photography-derived pectus excavatum depth to investigate whether both techniques could be used interchangeably to measure pectus excavatum depth and assess its evolution. The protocol consisted of three consecutive steps: patient positioning and instructions, data acquisition, and data processing. Three-dimensional imaging through the developed protocol was feasible for all 19 participants. The 3D image- and photography-derived pectus excavatum depth demonstrated good to excellent agreement (intraclass correlation coefficient: 0.97; 95%-confidence interval: 0.88 to 0.99; < 0.001). In conclusion, 3D imaging through the developed protocol is a feasible and attractive alternative to document the surface geometry of pectus excavatum and can be used interchangeably with conventional photography to determine pectus severity. NCT04185870.
Topics: Documentation; Funnel Chest; Humans; Imaging, Three-Dimensional; Photography; Thoracic Wall
PubMed: 32791868
DOI: 10.1080/17453054.2020.1784711