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BMJ Open Respiratory Research Jul 2021Pectus excavatum (PE) and pectus carinatum (PC) have generally been considered an aesthetic issue, although there is growing evidence of associated cardiopulmonary...
BACKGROUND
Pectus excavatum (PE) and pectus carinatum (PC) have generally been considered an aesthetic issue, although there is growing evidence of associated cardiopulmonary function (CPF) impairment, especially in PE patients. The study goal was to determine any correlation between pectus malformations and cardiopulmonary symptoms and function based on systematic assessment of CPF and thoracic measurements, such as Haller Index (HI) and sternal torsion angle (STA).
METHODS
Data from 76 adolescent patients with PE (n=30) or PC (n=46) were retrospectively collected referred between January 2015 and April 2018. CPF measurements and thoracic imaging were performed in all patients. HI and STA correction indexes were measured in all patients.
FINDINGS
Medical records from 76 patients (PE n=30; PC n=46) were analysed. Patients were predominantly male (>93.3%), and aged between 13 and 14½ old. PE was associated with airway obstruction, with a forced expiratory volume in 1 s value under the lower limit of normal in 13% of cases (p<0.001). Restrictive syndrome was observed in 23% of cases (p<0.001), with a Z score for total lung capacity under the lower limit of normal. In PC, pulmonary function was not affected. All patients showed slightly decreased values of left and right ejection fraction and cardiac index at rest, although values were within normal range. There were no significant correlations between pulmonary and cardiac functions or between low CPF and thoracic measurements.
INTERPRETATION
Our results confirm the modest impact of pectus malformations on CPF at rest, without correlation with anamnestic dyspnoea on exertion, nor with chest pain or anatomical measurements. Validation of new correction indexes could be helping characterise these malformations and choose optimal therapeutic management.
Topics: Adolescent; Adult; Aged; Aged, 80 and over; Forced Expiratory Volume; Funnel Chest; Humans; Male; Middle Aged; Retrospective Studies; Sternum; Thoracic Wall; Young Adult
PubMed: 34326157
DOI: 10.1136/bmjresp-2021-001020 -
Seminars in Thoracic and Cardiovascular... 2021Pectus excavatum is common in patients with connective tissue disorders or congenital heart disease undergoing cardiac surgery, and is occasionally severe enough to...
Pectus excavatum is common in patients with connective tissue disorders or congenital heart disease undergoing cardiac surgery, and is occasionally severe enough to warrant repair. The optimal surgical strategy is currently debated. We report our experience with simultaneous repair. From January 2012 to January 2020, 11 patients (median age of 35 ± 18 years, range 12-74) underwent a modified Ravitch procedure for severe pectus excavatum performed by a single thoracic surgeon at the time of simultaneous complex cardiac surgery. Eight patients (73%) had a confirmed connective tissue disorder and 2 patients (18%) had recurrent pectus excavatum following a failed Nuss procedure in adolescence. The mean Haller index was 7.3 ± 3.2 (range 3.8-13). The most common concomitant cardiac procedures were valve-preserving aortic root replacement (n=7, 64%) and mitral valve repair (n = 4, 36%). Patients are presented as a case series with descriptive analysis. The median total operative and cardiopulmonary bypass times were 400 minutes (±109 minutes) and 168 minutes (± 43 minutes), respectively. No deaths occurred in-hospital or during follow-up. There were no reoperations for bleeding, tamponade or other indications. No deep or superficial sternal wound infections occurred. Postoperative analgesia regimens were multimodal to facilitate early mobilization and pulmonary hygiene. None of the patients required prolonged ventilation or reintubation for respiratory failure. The mean stay in the intensive care unit was 82 hours (±56 hours) and the mean hospital stay was 9.1 days (2.4 days). Concurrent pectus excavatum repair at the time of cardiac surgery using a modified Ravitch technique can be safely performed by a multi-disciplinary team and should be considered for patients with multiple indications for operation.
Topics: Adolescent; Adult; Aged; Cardiac Surgical Procedures; Child; Funnel Chest; Humans; Length of Stay; Middle Aged; Reoperation; Retrospective Studies; Treatment Outcome; Young Adult
PubMed: 33689924
DOI: 10.1053/j.semtcvs.2021.02.028 -
The Annals of Thoracic Surgery Aug 2020Reoperation after failed pectus repair, Open or Nuss, is complex. In the majority of patients, metal bars or plates are used. Recently, an absorbable bar (poly-L-lactide...
BACKGROUND
Reoperation after failed pectus repair, Open or Nuss, is complex. In the majority of patients, metal bars or plates are used. Recently, an absorbable bar (poly-L-lactide [PLA]) was introduced for rib fixation. This series is my experience of using this biomaterial for reoperative pectus surgery.
METHODS
We respectively reviewed the medical records of all patients who were referred to our institution for pectus abnormalities; 180 patients were evaluated, 62 patients (34%) underwent reoperation.
RESULTS
Sixty-two patients underwent reoperative Open repair. Median age was 38 years (range 18-, 72 years); 39 (63%) were men. Thirty-two patients had Open repair for recurrent pectus using posterior sternal support with PLA bars, and 30 patients with acquired restrictive thoracic dystrophy had expansion surgery with multiple PLA bars. Median hospital stay was 7 days (4-21 days). Postoperative complications occurred in 22 patients (35%); late complications in 10 patients (16%); all required reoperation for incisional or soft tissue issues. No patient required reoperation for a pectus or acquired restrictive thoracic dystrophy recurrence. Patient satisfaction was excellent in 85%, good in 8%, fair in 4%, and poor in 3%.
CONCLUSIONS
Reoperative pectus surgery is complex and requires a detailed preoperative evaluation and individualized plan for correction. Use of PLA absorbable bars for sternal support and chest cavity expansion provides a safe alternative. Soft tissue complications are common and reversible; early results are promising in these challenging patients.
Topics: Adolescent; Adult; Aged; Biocompatible Materials; Female; Funnel Chest; Humans; Male; Middle Aged; Reoperation; Retrospective Studies; Young Adult
PubMed: 32251658
DOI: 10.1016/j.athoracsur.2020.02.070 -
PloS One 2019Pectus excavatum, thoracic spine deformities, tracheal hypoplasia and lateral heart displacement are frequently described in brachycephalic dog breeds. Pectus carinatum...
Prevalence of pectus excavatum (PE), pectus carinatum (PC), tracheal hypoplasia, thoracic spine deformities and lateral heart displacement in thoracic radiographs of screw-tailed brachycephalic dogs.
Pectus excavatum, thoracic spine deformities, tracheal hypoplasia and lateral heart displacement are frequently described in brachycephalic dog breeds. Pectus carinatum is described sporadically, although the authors' observations demonstrate that it may occur in certain brachycephalic dog breeds. It was hypothesised that dogs of screw-tailed brachycephalic breeds carry a greater risk of these anomalies than normal-tailed brachycephalic breeds, and that there could a relation between the presence of pectus excavatum or pectus carinatum and thoracic spine deformities, tracheal hypoplasia and lateral heart displacement. During retrospective studies, these anomalies were identified in lateral and dorso-ventral radiographs of the thorax in brachycephalic dog breeds. A statistical analysis revealed that the frequency of pectus excavatum occurrence in screw-tailed and normal-tailed brachycephalic dog breeds is similar. The greatest risk of pectus excavatum occurrence is carried by two breeds: Maltese (60%) and English Bulldog (58%), while for pectus carinatum: Pug (41%) and French Bulldog (18%). Dogs of screw-tailed brachycephalic breeds carry a greater risk of kyphosis (p < 0.0001), tracheal hypoplasia occurrence (p < 0.0001), compared to "normal-tailed" breeds. The hypothesis concerning a relation between the presence of pectus excavatum or pectus carinatum and the other anomalies studied was not confirmed (p > 0.05). It was demonstrated that in dogs of brachycephalic breeds there was a greater risk of co-incidence between kyphosis of the thoracic spine and lateral heart displacement (p = 0.038), as well as kyphosis of the thoracic spine and tracheal hypoplasia (p = 0.003).
Topics: Animals; Constriction, Pathologic; Dogs; Female; Funnel Chest; Heart Defects, Congenital; Male; Odds Ratio; Pectus Carinatum; Prevalence; Tail; Thoracic Vertebrae; Trachea
PubMed: 31600285
DOI: 10.1371/journal.pone.0223642 -
Revista Da Associacao Medica Brasileira... 2023Pectus excavatum is the most prevalently encountered deformity of the thoracic wall. It can be accompanied by congenital anomalies.
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.
Topics: Humans; Child; Funnel Chest; Heart Defects, Congenital; Prevalence
PubMed: 37466586
DOI: 10.1590/1806-9282.20221301 -
European Review For Medical and... Jul 2022Our primary objective was to identify discrete and syndromic cases of Pectus excavatum (PE) and Pectus carinatum (PC). We also intended to highlight the significance of...
OBJECTIVE
Our primary objective was to identify discrete and syndromic cases of Pectus excavatum (PE) and Pectus carinatum (PC). We also intended to highlight the significance of further genetic exploration in clinically suspected syndromic cases of PC and PE. Pectus excavatum (PE) and Pectus carinatum (PC) are the most common morphological chest wall deformities. Although various hypotheses have been put forth, the pathogenesis of both entities is largely unknown. Clinicians often refer such cases for further genetic evaluation to exclude an associated underlying connective tissue disorder or a syndrome. Additionally, a detailed anamnesis with focused family history and thorough dysmorphological physical examination was done. PE and PC are considered isolated abnormalities if there is the absence of features of other syndromes, eliminating the need for further genetic evaluations. It is believed that the pattern of inheritance of these non-syndromic isolated PE and PC cases with positive family history could be multifactorial in nature. The recurrence risk of such isolated cases is thought to be low. Further diagnostic studies are indicated as PE and PC could be a part of a syndrome. Among the many syndromes, the most common monogenic syndromes associated with PE and PC are Marfan's and Noonan's.
PATIENTS AND METHODS
After obtaining the consent, we compiled a database of the patients who presented with chest wall deformities during the period 2017-2019. We selected 70 cases with PC and PE deformities to identify the discrete and syndromic PC and PE cases. During the study, we perused the cytogenetic and/or molecular analyses, that had been conducted to confirm the clinically suspected syndromic cases. We also scrutinized for the presence of PC and PE cases that are associated with the rare syndrome (s).
RESULTS
Various genetic abnormalities were identified in 28 (40%) of the 70 cases that had been diagnosed with chest wall abnormalities. Along with PE and PC, other thoracic wall abnormalities were also identified, such as the broad chest, bell-shaped thorax, and elongated or enlarged thorax. One case of a rare genetic disorder of Morquio syndrome associated with PC was also identified. Novel (previously unpublished) genomic variants are reported here.
CONCLUSIONS
It is important to delve deeper when encountering cases of PE and PC by conducting a further genetic exploration of such cases to identify syndromic associations that cause other structural and functional disorders, diagnosis of which might be missed during the early developmental period. Early identification of such disorders may help us correcting the defects, slowing the progression of disease processes, and preparing better to deal with the potential outcome.
Topics: Funnel Chest; Humans; Pectus Carinatum; Risk Assessment; Syndrome; Thoracic Diseases; Thoracic Wall
PubMed: 35916808
DOI: 10.26355/eurrev_202207_29298 -
Multimedia Manual of Cardiothoracic... Dec 2021In the past, the treatment of pectus carinatum has been managed by open, invasive surgical procedures, which involved the resection of cartilage growth plates (Ravitch...
In the past, the treatment of pectus carinatum has been managed by open, invasive surgical procedures, which involved the resection of cartilage growth plates (Ravitch procedure). By preventing normal bony growth and maturity, this technique often led to postoperative complications, such as acquired thoracic dystrophy, chronic pain and scarring, and stiffness of the whole anterior chest. Dyspnea and exercise intolerance due to restricted thoracic space and cardiac compression were not uncommon as well. Over the last 2 decades, nonsurgical and minimally invasive approaches have gained ground because it was recognized that simple sternal compression was able to remodel the elastic anterior chest wall and therefore correct pectus carinatum adequately/efficiently, at least in children. However, failure of this compressive brace treatment is not uncommon in adolescents and older patients. Abramson therefore developed a minimally invasive technique for the correction of pectus carinatum using a pectus bar that is placed anteriorly to the sternum. The procedure is less invasive and less risky than a pectus bar inserted for pectus excavatum, but the lateral fixation of the pectus bar in the Abramson procedure remains a challenge. We demonstrate the technical aspects of the procedure step by step including our solution for fixation of the stabilizers.
Topics: Adolescent; Child; Funnel Chest; Humans; Minimally Invasive Surgical Procedures; Pectus Carinatum; Sternum; Treatment Outcome
PubMed: 34874627
DOI: 10.1510/mmcts.2021.082 -
Interactive Cardiovascular and Thoracic... Nov 2021This study investigates whether the surgical correction of chest deformity is associated with the growth of the lung parenchyma after surgery for pectus excavatum.
OBJECTIVES
This study investigates whether the surgical correction of chest deformity is associated with the growth of the lung parenchyma after surgery for pectus excavatum.
METHODS
Ten patients with pectus excavatum who were treated by the Nuss procedure were examined. The preoperative and postoperative computed tomography (2.5 ± 1.2 years after surgery) scans were performed, and the Haller index, lung volume and lung density were analyzed using a three-dimensional image analysis system (SYNAPSE VINCENT, Fujifilm, Japan). The radiological lung weight was calculated as follows: lung volume (ml) × lung density (g/ml).
RESULTS
The average age of the 10 patients (men 8; women 2) was 13.8 years (range: 6-26 years). The Haller index was significantly improved from the preoperative value of 5.18 ± 2.20 to the postoperative value of 3.68 ± 1.38 (P = 0.0025). Both the lung volume and weight had significantly increased by 107.1 ± 19.6% and 121.6 ± 11.3%, respectively, after surgery.
CONCLUSIONS
A significant increase in the weight of the lung after surgical correction suggests that the growth of the lung parenchyma is associated with the correction of chest deformity in younger patients with pectus excavatum.
Topics: Adolescent; Adult; Child; Female; Funnel Chest; Humans; Imaging, Three-Dimensional; Lung; Male; Organ Size; Postoperative Period; Tomography, X-Ray Computed; Young Adult
PubMed: 34423359
DOI: 10.1093/icvts/ivab203 -
Pediatric Surgery International Jun 2021The present study aimed to compare the physical and psychosocial conditions of adolescents with pectus excavatum (PE) and pectus carinatum (PC), who had mild-severe... (Comparative Study)
Comparative Study
PURPOSE
The present study aimed to compare the physical and psychosocial conditions of adolescents with pectus excavatum (PE) and pectus carinatum (PC), who had mild-severe deformities, with those of healthy controls (HC).
METHODS
This study included 180 adolescents (aged 10-18 years) with pectus deformity [PE (n = 90) and PC (n = 90)] and 90 age-matched HC. The following parameters were evaluated for each participant: clinical parameters, perceived appearance of the chest area (PAC), physical functions (grip strength, flexibility, muscle strength, endurance, physical activity), posture, psychosocial conditions, and quality of life (QOL).
RESULTS
Patients with PE and PC had a lower body weight, a worse, a poorer posture, lower scores for physical functions compared to the HC group (p < 0.001, all). The PE group had lower scores (p < 0.05) for some psychosocial conditions and quality of life subscales compared to the HC and PC (except for the QOL) group (p < 0.05). The PC group had a poorer posture compared to the PE group (p < 0.05). PAC was associated with physical functions and psychosocial status (r = 0.19-0.40, p < 0.05) but pectus severity was not associated with these parameters (r = 0.02-0.12, p > 0.05).
CONCLUSION
Our results indicate that all adolescents with mild, moderate, or severe pectus deformity should undergo a biopsychosocial evaluation, receive psychosocial support, and be referred for physiotherapy.
Topics: Adolescent; Child; Exercise; Female; Funnel Chest; Humans; Male; Pectus Carinatum; Quality of Life
PubMed: 33454849
DOI: 10.1007/s00383-021-04857-7 -
Journal of Thoracic Disease Jul 2023The minimally invasive repair of pectus excavatum (MIRPE) is widely accepted as a method of pectus excavatum (PE) repair. Repair is rarely performed in patients with a... (Review)
Review
The minimally invasive repair of pectus excavatum (MIRPE) is widely accepted as a method of pectus excavatum (PE) repair. Repair is rarely performed in patients with a history of median sternotomy. A feared complication of this procedure is iatrogenic cardiac injury; the risk of injury in patients with prior sternotomy is especially high due to the development of post-surgical retrosternal adhesions, which obscures the "critical view" during MIRPE. A 14-center review reported the incidence to be as high as 7% after analyzing 75 patients with history of sternotomy who underwent MIRPE. Little literature exists on how to best prepare for MIRPE in patients with prior sternotomy. A review of the literature and a retrospective review of over 2,200 patients who underwent MIRPE at our institution was performed to analyze 9 patients who underwent MIRPE after prior sternotomy. Iatrogenic cardiac injury occurred in 2 patients. Given the infrequency in our experience and the low numbers reported in the literature, statistical conclusions cannot be drawn. However, prudent strategies based on this experience include thoracoscopy, routine sternal elevation, direct sub-xiphoid retrosternal dissection, coordination with cardio-thoracic surgeons, preparation for cardio-pulmonary bypass, and massive transfusion protocol availability to optimize surgical outcomes in patients undergoing MIRPE with a history of sternotomy.
PubMed: 37559617
DOI: 10.21037/jtd-22-1567