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Annals of Translational Medicine Dec 2023Minimally invasive repair of pectus excavatum (MIRPE) is a popular method for surgical correction of PE, and its impact on quality of life is a growing area of interest....
BACKGROUND
Minimally invasive repair of pectus excavatum (MIRPE) is a popular method for surgical correction of PE, and its impact on quality of life is a growing area of interest. We performed a systematic review and meta-analysis to evaluate the impact of MIRPE on the quality of life of patients.
METHODS
This study was registered with PROSPERO under reference number CRD42020222061. A literature search of PubMed, Cochrane Library, EMBASE and Scopus was conducted from the date of inception till November 23, 2020. We included studies which administered one or more questionnaires on patients up to 60 years old, parents or both, to assess the quality of life before and after MIRPE. Studies not written in English, abstracts, articles without primary data, reviews and studies which combined data on PE and other deformities were excluded. Risk of bias was assessed using the Risk of Bias in Non-randomised Studies of Interventions and the Cochrane risk of bias tool. A random-effects meta-analysis was performed to obtain mean differences for key themes of quality of life before and after MIRPE. Responses from the same questionnaires, as well as common themes across different questionnaires, were compared.
RESULTS
Of the 20 studies identified for systematic review, 7 studies that reported the responses of 478 patients were included in the meta-analysis. Patients who underwent MIRPE experienced an increased self-esteem [standardized mean difference (SMD): 1.38, 95% confidence interval (CI): 0.95 to 1.81, P<0.00001] and a smaller degree of chest interference with their social activities (SMD: 0.84, 95% CI: 0.60 to 1.08, P<0.00001). These findings were consistent even after the implanted bar was removed.
CONCLUSIONS
MIRPE may be associated with a better quality of life for patients with PE as self-esteem and extent of chest interference with social activities are improved after the procedure. The key limitations of this study are the lack of high-quality evidence due to paucity of randomized trials, and the significant heterogeneity in reported outcomes due to variations in the questionnaires and timepoints of administration.
PubMed: 38213813
DOI: 10.21037/atm-23-1647 -
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 -
World Journal of Pediatric Surgery 2020Pectus excavatum, the most common chest wall deformity in children, accounts for nearly 90% of congenital malformations of chest wall. Initially, both parents and... (Review)
Review
BACKGROUND
Pectus excavatum, the most common chest wall deformity in children, accounts for nearly 90% of congenital malformations of chest wall. Initially, both parents and doctors paid more attention to the influence of this deformity on patient appearance and psychology. Following deeper studies of pectus excavatum, researchers found that it also affected cardiac functions. The purpose of this review aims to present recent research progress in the effects of pectus excavatum on cardiac functions.
DATA SOURCES
Based on aspects of CT, ultrasound cardiography (UCG) and MRI, all the recent literatures on the influence of pectus excavatum on cardiac function were searched and reviewed.
RESULTS
Moderate and severe pectus excavatum did have a negative effect on cardiac function. Cardiac rotation angle, cardiac compression index, right atrial and tricuspid annulus size, septal motion and myocardial strain are relatively effective indexes to evaluate cardiac function.
CONCLUSIONS
Pectus excavatum did have a negative effect on cardiac function; so surgeons should actively diagnose and treat such patients in clinical work. However, further research is needed on to explore the measures and indicators that can reflect the changes of cardiac function in patients objectively, accurately, effectively and timely.
PubMed: 36474921
DOI: 10.1136/wjps-2020-000142 -
Thorax Sep 1969The deformity of pectus excavatum is caused by a negative pressure in the anterior mediastinum sucking in the body of the sternum. This is usually due to the heart lying...
The deformity of pectus excavatum is caused by a negative pressure in the anterior mediastinum sucking in the body of the sternum. This is usually due to the heart lying on the left side, leaving the mediastinum empty so that the sternum and costal cartilages are sucked in to fill the empty space. The operation consists of excising the deformed cartilages, mobilizing the sternum, and suturing the pericardial sac into a central position which corrects the deformity.
Topics: Adolescent; Adult; Cartilage; Child; Funnel Chest; Heart Defects, Congenital; Humans; Male; Mediastinum; Pericardium; Pressure; Sternum
PubMed: 5348322
DOI: 10.1136/thx.24.5.557 -
The Pan African Medical Journal 2021
PubMed: 34367426
DOI: 10.11604/pamj.2021.38.347.28813 -
Jornal Brasileiro de Pneumologia :... Mar 2009To determine the prevalence of congenital anterior chest wall deformities in 11- to 14-year-old students.
OBJECTIVE
To determine the prevalence of congenital anterior chest wall deformities in 11- to 14-year-old students.
METHODS
Students participating in the study were recruited from public schools in the city of Manaus, Brazil. The statistically significant sample (precision, 1%; 95% CI) comprised 1,332 students. Pectus deformities were identified by physical examination of the chest, and the individuals with one of these deformities completed a questionnaire regarding heredity and symptoms resulting from the chest abnormality.
RESULTS
The mean age of the participants was 11.7 years. The prevalence of pectus abnormalities was 1.95% (pectus excavatum: 1.275%; pectus carinatum: 0.675%). Of the 26 students with a pectus deformity, 17 (65.4%) had pectus excavatum, and 18 (69.2%) were male. Concomitant scoliosis was observed in 3 cases (11.5%). A family history of pectus was reported by 17 students (65.4%), and 17 (65.4%) reported chest pain, dyspnea or palpitations.
CONCLUSIONS
In this study, the prevalence of pectus deformities (1.95%) was lower than that reported in other studies conducted in Brazil (3.6-4.9%) but was higher than that reported in the literature (mean, 1%).
Topics: Adolescent; Brazil; Child; Female; Funnel Chest; Humans; Male; Musculoskeletal Abnormalities; Prevalence; Reproducibility of Results; Students; Thoracic Wall
PubMed: 19390719
DOI: 10.1590/s1806-37132009000300005 -
Frontiers in Pediatrics 2022The outcome of vacuum bell (VB) treatment for preschool patients with pectus excavatum (PE) is poorly understood. We aim to investigate the short-term treatment effect...
OBJECTIVE
The outcome of vacuum bell (VB) treatment for preschool patients with pectus excavatum (PE) is poorly understood. We aim to investigate the short-term treatment effect of VB with a three-dimensional scanner and assess the clinical and demographic factors that might influence treatment outcomes.
METHODS
We conducted a chart review study to review the records of preschool patients with PE who received VB treatment in a tertiary hospital from January 1, 2021, through January 1, 2022. Demographic data and chest wall deformity assessments were recorded at follow-up, including the anterior chest wall depths and depth ratio (DR). The demographic and clinical factors influencing treatment outcomes were tested using a logistic regression model.
RESULTS
139 patients who accepted vacuum bell treatment were included in the final study analysis, with a mean age of 4.6 years and a BMI of 14.9. Forty-three patients (30.9%) with a depth of less than 3 mm met the termination criteria and showed cosmetic results. The changes in depths ( < 0.001) and DR ( < 0.001) were statistically significant in 55 patients with three or four follow-ups. Multifactor logistic regression analysis showed that initial depth (OR 0.69, 95% CI 0.58-0.84, < 0.001) and treatment period (OR 1.58, 95% CI 1.23-2.04, < 0.001) were independent predictors of achieving complete correction.
CONCLUSION
VB is an effective treatment modality in preschool patients in the short-term follow-up, which is influenced by the depth of depression and the duration of treatment. However, further prospective studies are needed to confirm these results.
PubMed: 36313864
DOI: 10.3389/fped.2022.1008437 -
The British Journal of Radiology 2016To identify the anatomy and pathology of chest wall malformations presenting for consideration for corrective surgery or as a possible chest wall "mass", and to review... (Review)
Review
To identify the anatomy and pathology of chest wall malformations presenting for consideration for corrective surgery or as a possible chest wall "mass", and to review the common corrective surgical procedures. Congenital chest wall deformities are caused by anomalies of chest wall growth, leading to sternal depression or protrusion, or are related to failure of normal spine or rib development. Cross-sectional imaging allows appreciation not only of the involved structures but also assessment of the degree of displacement or deformity of adjacent but otherwise normal structures and differentiation between anatomical deformity and neoplasia. In some cases, CT is also useful for surgical planning. The use of three-dimensional reconstructions, utilizing a low-dose technique, provides important information for the surgeon to discuss the nature of anatomical abnormalities and planned corrections with the patient and often with their parents. In this pictorial essay, we discuss the radiological features of the commonest congenital chest wall deformities and illustrate pre- and post-surgical appearances for those undergoing surgical correction.
Topics: Adult; Female; Funnel Chest; Humans; Imaging, Three-Dimensional; Male; Sternum; Thoracic Diseases; Thoracic Wall; Tomography, X-Ray Computed; Young Adult
PubMed: 26916279
DOI: 10.1259/bjr.20150595 -
Journal of Healthcare Engineering 2017There is high risk in the correction surgery of pectus excavatum with scoliosis because of the lack of the correction mechanism of pectus excavatum with scoliosis. This...
BACKGROUND
There is high risk in the correction surgery of pectus excavatum with scoliosis because of the lack of the correction mechanism of pectus excavatum with scoliosis. This study performed a comprehensive analysis about the impact that pectus excavatum had on scoliosis and elaborated its biomechanical mechanism in pectus excavatum patients with scoliosis.
METHODS
37 pectus excavatum patients were selected. According to age, Haller index of pectus excavatum, offset coefficient, vertical position, sternal torsion angle, and asymmetric index, 37 patients were, respectively, divided into 2 compared groups. The result was statistically calculated.
RESULTS
The scoliosis incidence and severity did not correlate with Haller index, offset coefficient, vertical position, sternal torsion angle, and asymmetric index of pectus excavatum, and there was no statistical significance between the two compared groups.
CONCLUSIONS
The incidence and severity of scoliosis in PE patients with scoliosis have nothing to do with the geometric parameters of pectus excavatum but correlate with age. The scoliosis will aggravate with the increase of age. The heart may provide an asymmetric horizontal force to push the spines to the right. The mechanism of how the biomechanical factors exert influences on spines needs to be further investigated to keep the spine stable.
Topics: Adolescent; Adult; Child; Child, Preschool; Female; Funnel Chest; Humans; Male; Radiography, Thoracic; Scoliosis; Severity of Illness Index; Thoracic Vertebrae; Thoracoplasty; Tomography, X-Ray Computed; Young Adult
PubMed: 29065615
DOI: 10.1155/2017/5048625 -
European Radiology Mar 2023The breathing phase for the determination of thoracic indices in patients with pectus excavatum is not standardized. The aim of this study was to identify the best...
OBJECTIVES
The breathing phase for the determination of thoracic indices in patients with pectus excavatum is not standardized. The aim of this study was to identify the best period for reliable assessments of morphologic indices by dynamic observations of the chest wall using real-time MRI.
METHODS
In this prospective study, patients with pectus excavatum underwent morphologic evaluation by real-time MRI at 3 T between January 2020 and June 2021. The Haller index (HI), correction index (CI), modified asymmetry index (AI), and modified eccentricity index (EI) were determined during free, quiet, and forced breathing respectively. Breathing-related differences in the thoracic indices were analyzed with the Wilcoxon signed-rank test. Motion of the anterior chest wall was analyzed as well.
RESULTS
A total of 56 patients (11 females and 45 males, median age 15.4 years, interquartile range 14.3-16.9) were included. In quiet expiration, the median HI in the cohort equaled 5.7 (4.5-7.2). The median absolute differences (Δ) in the thoracic indices between peak inspiration and peak expiration were ΔHI = 1.1 (0.7-1.6, p < .001), ΔCI = 4.8% (1.3-7.5%, p < .001), ΔAI = 3.0% (1.0-5.0%, p < .001), and ΔEI = 8.0% (3.0-14.0%, p < .05). The indices varied significantly during different inspiratory phases, but not during expiration (p > .05 each). Furthermore, the dynamic evaluation revealed three distinctive movement patterns of the funnel chest.
CONCLUSIONS
Real-time MRI reveals patterns of chest wall motion and indicate that thoracic indices of pectus excavatum should be assessed in the end-expiratory phase of quiet expiration.
KEY POINTS
• The thoracic indices in patients with pectus excavatum depend on the breathing phase. • Quiet expiration represents the best breathing phase for determining thoracic indices. • Real-time MRI can identify different chest wall motion patterns in pectus excavatum.
Topics: Male; Female; Humans; Adolescent; Funnel Chest; Prospective Studies; Thorax; Magnetic Resonance Imaging; Motion
PubMed: 36307555
DOI: 10.1007/s00330-022-09197-1