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Walsh J, Walsh R, Redmond K. Systematic review of physiological and psychological outcomes of surgery for pectus excavatum supporting commissioning of service in the UK. BMJ Open Respir Res 2023; 10:e001665. [PMID: 37827806 PMCID: PMC10582895 DOI: 10.1136/bmjresp-2023-001665] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2023] [Accepted: 07/28/2023] [Indexed: 10/14/2023] Open
Abstract
BACKGROUND Pectus excavatum (PEx) is the most common congenital chest wall abnormality affecting 1 in 400 births in the UK. PEx is associated with significant physiological and psychological impairment. While readily surgically correctable, the benefits that surgery can bring have been debated and proven difficult to objectively measure. In the UK, this has led to the decommissioning of PEx surgery. The aim of this review is to conduct a systematic search of the literature on PEx surgery to assess physiological and psychological outcomes. METHODS A systematic review of the MEDLINE (PubMed), Embase and Cochrane databases was performed. Articles were sought which included patients undergoing surgery for PEx and reported on changes in cardiopulmonary measures, symptoms, quality of life and psychological assessments before and after surgical repair. Last search was performed in July 2022 and relevant findings were synthesised by narrative review. RESULTS Fifty-one articles were included in qualitative synthesis, with 34 studies relating to physiological outcomes and 17 studies relating to psychological and quality of life measures. Twenty-one studies investigated pulmonary function at rest. There was no change in forced vital capacity or forced expiratory volume in 1 second following open repair and transient reductions followed closed repair. In the 11 studies investigating echocardiography, transthoracic rarely demonstrated cardiac compression; however, transoesophageal demonstrated intraoperative relief in cardiac compression in severe cases. Sixteen studies investigated exercise testing (cardiopulmonary exercise testing, CPET), 12 of which demonstrated significant improvement following surgery, both in maximal oxygen consumption and oxygen pulse. Seventeen studies investigated quality of life, all but one of which showed improvement following repair of PEx. All papers that reported on patient satisfaction following surgery found high rates, between 80% and 97%. DISCUSSION While the majority of studies to date have been small and data heterogeneous, the literature shows that for many patients with PEx, there exists a cardiopulmonary limitation that while difficult to objectify, is likely to improve with surgical repair. Resting parameters offer little yield in aiding this except in the most severe cases. CPET therefore offers a better option for dynamic assessment of this limitation and improvements following repair. Surgery significantly improves psychological well-being and quality of life for patients with PEx.
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Affiliation(s)
- Jamie Walsh
- Department of Cardiothoracic Surgery, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Ross Walsh
- Department of Cardiothoracic Surgery, Fiona Stanley Hospital, Murdoch, Western Australia, Australia
| | - Karen Redmond
- Cardiothoracic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland
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2
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Akhtar M, Razick DI, Saeed A, Baig O, Kamran R, Ansari U, Sajid Z, Rahman JE. Complications and Outcomes of the Nuss Procedure in Adult Patients: A Systematic Review. Cureus 2023; 15:e35204. [PMID: 36960268 PMCID: PMC10031548 DOI: 10.7759/cureus.35204] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 02/22/2023] Open
Abstract
Pectus excavatum is a congenital chest wall deformity, commonly identified in early childhood, creating a "sunken chest" appearance. Over time, the deformity can worsen, thus impacting cardiopulmonary function and creating significant body image disturbance in patients. The Nuss procedure is a minimally invasive technique in which a curved steel bar is introduced underneath the sternum through small bilateral thoracic incisions to correct the deformity. Most studies regarding the procedure to date focus on outcomes and complications in pediatric patients, however, few studies discuss these results in adult patients. This systematic review aims to analyze common complications and outcomes in patients over the age of 18 who have not undergone any prior intervention for pectus excavatum. The most common complications experienced in adult patients were displacement of the implanted steel bar, infection of the surgical site, pneumothorax, pleural effusion, and chronic postoperative pain. Reoperation was common in patients with a displacement of the bar, chronic pain, and bleeding. Additionally, adult patients routinely required a higher number of steel bars to be placed to correct the deformity. Despite evidence that the rate of complications increases with age, the majority of adult patients in our included studies were satisfied with the outcome of the procedure with indications of improved self-image and reduced preoperative symptoms such as dyspnea on exertion, palpitations, chest pain, and depression.
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Affiliation(s)
- Muzammil Akhtar
- Surgery, California Northstate University College of Medicine, Elk Grove, USA
| | - Daniel I Razick
- Surgery, California Northstate University College of Medicine, Elk Grove, USA
| | - Ali Saeed
- Internal Medicine, William Carey University College of Osteopathic Medicine, Hattiesburg, USA
| | - Osamah Baig
- Ophthalmology, Lake Erie College of Osteopathic Medicine, Erie, USA
| | - Rafaay Kamran
- Molecular Biology, University of California Berkeley, Berkeley, USA
| | - Ubaid Ansari
- Internal Medicine, California Northstate University College of Medicine, Elk Grove, USA
| | - Zahra Sajid
- Biology, Cosumnes River College, Elk Grove, USA
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3
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Kar A, Baghai M, Hunt I. Reshaping the Evidence for Surgical Correction of Pectus Excavatum Using Cardiopulmonary Exercise Testing. J Am Heart Assoc 2022; 11:e025273. [PMID: 35377161 PMCID: PMC9075475 DOI: 10.1161/jaha.122.025273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ashok Kar
- Department of Thoracic Surgery St Georges Hospital NHS Foundation Trust London United Kingdom
| | - Max Baghai
- Department of Cardiothoracic Surgery King's College Hospital NHS Foundation Trust London United Kingdom
| | - Ian Hunt
- Department of Thoracic Surgery St Georges Hospital NHS Foundation Trust London United Kingdom
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4
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de Loos ER, Daemen JHT, Coorens NA, Maessen JG, Vissers YLJ, Hulsewé KWE. Sternal elevation by the crane technique during pectus excavatum repair: A quantitative analysis. JTCVS Tech 2021; 9:167-175. [PMID: 34647091 PMCID: PMC8501226 DOI: 10.1016/j.xjtc.2021.05.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/25/2021] [Indexed: 12/02/2022] Open
Abstract
Introduction The crane technique is used to facilitate sternal elevation to provide safe mediastinal passage during the Nuss procedure. The aim was to objectively quantitate the elevation of the crane by 3-dimensional chest images acquired during the Nuss procedure. Methods A prospective cohort study was conducted. Patients undergoing the Nuss procedure were eligible. Sternal elevation was achieved by the crane technique providing a simultaneous lift of the anterior chest wall and reduction of the pectus excavatum depth. Both effects were evaluated. Three-dimensional surface images were acquired before incision, following sternal lift, and after bar implantation and quantitatively compared. Reduction of the external pectus excavatum depth was expressed as a percentage. Results Thirty patients were included. Ninety percent were male, with a median age of 15.5 years (interquartile range [IQR], 14.5-17.4), Haller index of 3.56 (IQR, 3.09-4.65), and external pectus depth of 18 mm (IQR, 11-23). Sternal elevation by the crane provided a median 78% (IQR, 63-100) reduction of the deformity, corresponding with a residual depth of 3 mm (IQR, 0-7). The percentual reduction diminished with increasing depth of the sternal depression (correlation, –0.86). Besides reducing the deformity, the crane caused an elevation of the anterior chest over a large surface area with a maximum lift of 26 mm (IQR, 19-32). Conclusions The crane is an effective sternal elevation technique, providing 78% reduction of the sternal depression, although its effect lessens with increasing depth. In addition, it produces an elevation of the anterior chest over a large surface area.
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Affiliation(s)
- Erik R de Loos
- Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Jean H T Daemen
- Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands.,Faculty of Health, Medicine and Life Sciences (FHML), School for Oncology and Developmental Biology (GROW), Maastricht, The Netherlands
| | - Nadine A Coorens
- Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Jos G Maessen
- Department of Cardiothoracic Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.,Faculty of Health, Medicine and Life Sciences (FHML), Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands
| | - Yvonne L J Vissers
- Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
| | - Karel W E Hulsewé
- Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Center, Heerlen, The Netherlands
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5
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Dada RS, Hayanga JW, Abbas Khan MA, Toker A, Hayanga HK. A 36-Year-Old Female With Congenital Contractural Arachnodactyly and Pectus Excavatum Requiring Fourth-Time Redo Surgical Correction. Cureus 2021; 13:e16701. [PMID: 34466327 PMCID: PMC8397513 DOI: 10.7759/cureus.16701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2021] [Indexed: 11/14/2022] Open
Abstract
Congenital contractural arachnodactyly (CCA) is a rare connective tissue disorder that has several phenotypic similarities to Marfan syndrome. Among the phenotypic characteristics of patients with CCA, severe kyphoscoliosis and thoracic cage abnormalities are commonly reported. In this case report, we describe a patient with coexisting CCA and severe pectus excavatum requiring multiple surgical repairs. The impact severe scoliosis and pectus excavatum in isolation have on cardiopulmonary anatomy and physiology can be significant, and their effects can be profound concomitantly. These defects have the propensity of causing restrictive lung disease and external cardiac compression.
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Affiliation(s)
- Rachel S Dada
- Department of Anesthesiology, West Virginia University, Morgantown, USA
| | - Jeremiah W Hayanga
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, USA
| | - Mir Ali Abbas Khan
- Department of Cardiovascular and Thoracic Anesthesiology, West Virginia University, Morgantown, USA
| | - Alper Toker
- Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, USA
| | - Heather K Hayanga
- Department of Cardiovascular and Thoracic Anesthesiology, West Virginia University, Morgantown, USA
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6
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Raggio IM, Martínez-Ferro M, Bellía-Munzón G, Capunay C, Munín M, Toselli L, Carrascosa P, Rodríguez-Granillo GA. Diastolic and Systolic Cardiac Dysfunction in Pectus Excavatum: Relationship to Exercise and Malformation Severity. Radiol Cardiothorac Imaging 2020; 2:e200011. [PMID: 33778619 DOI: 10.1148/ryct.2020200011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2020] [Revised: 06/11/2020] [Accepted: 07/10/2020] [Indexed: 11/11/2022]
Abstract
Purpose To explore stress echocardiographic findings among patients with pectus excavatum (PEX) and their relationship with malformation severity. Materials and Methods A prospective registry involving consecutive patients with a diagnosis of isolated PEX referred to undergo chest CT and stress echocardiography to evaluate surgical candidacy and/or to define treatment strategies was developed. Malformation indexes were evaluated using chest CT. Results This study included 269 patients with PEX (19.7 years ± 7.8 [standard deviation]; 245 men) and 35 healthy volunteers (20.7 years ± 6.1; 21 men). Patients with PEX achieved a lower maximal workload (PEX group, 8.2 metabolic equivalents ± 1.7; control group, 11.8 metabolic equivalents ± 5.5; P < .0001). This study identified evidence of abnormal right ventricular diastolic function in 29% of patients with PEX and identified no evidence of this among those in the control group (P < .0001). Healthy controls showed a 37% increment in the tricuspid area during exercise, compared with 4% in patients with PEX (P = .002). Right ventricular systolic function was significantly lower in patients with PEX than in controls, both measured using tricuspid annulus plane systolic excursion (stress, 25.0 mm ± 5.5 vs 35.4 mm ± 3.7; P < .0001), and the tricuspid systolic wave was also smaller (stress, 16.9 cm/sec ± 4.5 vs 20.5 cm/sec ± 3.9; P < .0001). During stress, significant associations were detected between malformation indexes with right ventricular systolic and diastolic findings (P < .05 for all). Conclusion This study identified evidence of diverse adverse functional and morphologic cardiac manifestations in PEX, involving signs of abnormal diastolic and systolic right ventricular function and compression of the atrioventricular groove, which worsened during stress and were related to malformation severity.© RSNA, 2020: An earlier incorrect version of this article appeared online. This article was corrected on October 19, 2020.
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Affiliation(s)
- Ignacio M Raggio
- Department of Cardiology, Clínica Olivos, Buenos Aires, Argentina (I.M.R.); Department of Cardiology, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires, Argentina (I.M.R., M.M.); Department of Surgery, Fundación Hospitalaria, Private Children's Hospital, Buenos Aires, Argentina (M.M.F., G.B.M., L.T.); Department of Cardiovascular Imaging, Diagnostico Maipú, Av. Maipú 1668, Vicente López, Buenos Aires, Argentina (C.C., P.C., G.A.R.G.); and Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina (G.A.R.G.)
| | - Marcelo Martínez-Ferro
- Department of Cardiology, Clínica Olivos, Buenos Aires, Argentina (I.M.R.); Department of Cardiology, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires, Argentina (I.M.R., M.M.); Department of Surgery, Fundación Hospitalaria, Private Children's Hospital, Buenos Aires, Argentina (M.M.F., G.B.M., L.T.); Department of Cardiovascular Imaging, Diagnostico Maipú, Av. Maipú 1668, Vicente López, Buenos Aires, Argentina (C.C., P.C., G.A.R.G.); and Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina (G.A.R.G.)
| | - Gastón Bellía-Munzón
- Department of Cardiology, Clínica Olivos, Buenos Aires, Argentina (I.M.R.); Department of Cardiology, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires, Argentina (I.M.R., M.M.); Department of Surgery, Fundación Hospitalaria, Private Children's Hospital, Buenos Aires, Argentina (M.M.F., G.B.M., L.T.); Department of Cardiovascular Imaging, Diagnostico Maipú, Av. Maipú 1668, Vicente López, Buenos Aires, Argentina (C.C., P.C., G.A.R.G.); and Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina (G.A.R.G.)
| | - Carlos Capunay
- Department of Cardiology, Clínica Olivos, Buenos Aires, Argentina (I.M.R.); Department of Cardiology, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires, Argentina (I.M.R., M.M.); Department of Surgery, Fundación Hospitalaria, Private Children's Hospital, Buenos Aires, Argentina (M.M.F., G.B.M., L.T.); Department of Cardiovascular Imaging, Diagnostico Maipú, Av. Maipú 1668, Vicente López, Buenos Aires, Argentina (C.C., P.C., G.A.R.G.); and Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina (G.A.R.G.)
| | - Martín Munín
- Department of Cardiology, Clínica Olivos, Buenos Aires, Argentina (I.M.R.); Department of Cardiology, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires, Argentina (I.M.R., M.M.); Department of Surgery, Fundación Hospitalaria, Private Children's Hospital, Buenos Aires, Argentina (M.M.F., G.B.M., L.T.); Department of Cardiovascular Imaging, Diagnostico Maipú, Av. Maipú 1668, Vicente López, Buenos Aires, Argentina (C.C., P.C., G.A.R.G.); and Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina (G.A.R.G.)
| | - Luzía Toselli
- Department of Cardiology, Clínica Olivos, Buenos Aires, Argentina (I.M.R.); Department of Cardiology, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires, Argentina (I.M.R., M.M.); Department of Surgery, Fundación Hospitalaria, Private Children's Hospital, Buenos Aires, Argentina (M.M.F., G.B.M., L.T.); Department of Cardiovascular Imaging, Diagnostico Maipú, Av. Maipú 1668, Vicente López, Buenos Aires, Argentina (C.C., P.C., G.A.R.G.); and Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina (G.A.R.G.)
| | - Patricia Carrascosa
- Department of Cardiology, Clínica Olivos, Buenos Aires, Argentina (I.M.R.); Department of Cardiology, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires, Argentina (I.M.R., M.M.); Department of Surgery, Fundación Hospitalaria, Private Children's Hospital, Buenos Aires, Argentina (M.M.F., G.B.M., L.T.); Department of Cardiovascular Imaging, Diagnostico Maipú, Av. Maipú 1668, Vicente López, Buenos Aires, Argentina (C.C., P.C., G.A.R.G.); and Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina (G.A.R.G.)
| | - Gastón A Rodríguez-Granillo
- Department of Cardiology, Clínica Olivos, Buenos Aires, Argentina (I.M.R.); Department of Cardiology, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno, Buenos Aires, Argentina (I.M.R., M.M.); Department of Surgery, Fundación Hospitalaria, Private Children's Hospital, Buenos Aires, Argentina (M.M.F., G.B.M., L.T.); Department of Cardiovascular Imaging, Diagnostico Maipú, Av. Maipú 1668, Vicente López, Buenos Aires, Argentina (C.C., P.C., G.A.R.G.); and Consejo Nacional de Investigaciones Científicas y Técnicas, Buenos Aires, Argentina (G.A.R.G.)
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7
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Monti L, Montini O, Voulaz E, Maagaard M, Morenghi E, Pilegaard HK, Infante M. Cardiovascular magnetic resonance assessment of biventricular changes during vacuum bell correction of pectus excavatum. J Thorac Dis 2020; 11:5398-5406. [PMID: 32030258 DOI: 10.21037/jtd.2019.12.41] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Evidence of cardiac dysfunction in patients with pectus excavatum (PE) remains controversial. A growing number of studies report increased exercise tolerance following surgery. Nevertheless, many consider the correction of PE a cosmetic intervention, with post-operative changes ascribed to the concurrent growth of the young patient population. No studies have investigated non-invasively the immediate cardiac changes following relief of the deformity. The aim of this study was to assess cardiac function before and during temporary sternal elevation using the non-invasive vacuum bell (VB) device on young adults with PE. Methods Adult patients scheduled for surgical correction of PE underwent cardiac magnetic resonance imaging (CMRI) before and during the application of the VB. Steady-state free precession sequences were used for the evaluation of biventricular volume and function. Phase contrast sequences measured the aortic and pulmonary flow to calculate stroke index (SI). Scans were analyzed post hoc by the same investigator. A control group of healthy individuals was assessed in the same way. Results In total, 20 patients with PE (mean age 23±10 years) and 10 healthy individuals (mean age 25±6 years) underwent CMR before and during VB application. Before intervention, baseline cardiac volumes and function were similar between the groups, with patient-values in the low-to-normal range. Following VB application, PE patients revealed a 10% increase in biventricular SI. Furthermore, left ventricular end-diastolic volume index (LV EDVI) improved by 8% and right ventricular ejection fraction (RV EF) increased by 7%. These findings were not mirrored in the healthy individuals. No correlations were found between improved cardiac parameters and the baseline Haller index (HI) of PE patients. Conclusions Non-invasive, momentary correction of PE is associated with an immediate improvement in SI, RV EF and LV EDVI, not observed in controls. The findings suggest that sternal depression in PE patients affects cardiac function.
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Affiliation(s)
- Lorenzo Monti
- Department of Radiology ¸ Humanitas Research Hospital, Milan, Italy.,Department of Cardiology ¸ Humanitas Research Hospital, Milan, Italy
| | - Orsola Montini
- Department of Radiology ¸ Humanitas Research Hospital, Milan, Italy.,Department of Cardiology ¸ Humanitas Research Hospital, Milan, Italy
| | - Emanuele Voulaz
- Department of Thoracic Surgery¸ Humanitas Research Hospital, Milan, Italy
| | - Marie Maagaard
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | | | - Hans K Pilegaard
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Aarhus, Denmark.,Department of Clinical Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Maurizio Infante
- Department of Thoracic Surgery¸ Humanitas Research Hospital, Milan, Italy.,Dipartimento Cardiovascolare e Toracico Azienda Ospedaliera Universitaria Integrata, Verona, Italy
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8
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Ewais MM, Chaparala S, Uhl R, Jaroszewski DE. Outcomes in adult pectus excavatum patients undergoing Nuss repair. PATIENT-RELATED OUTCOME MEASURES 2018; 9:65-90. [PMID: 29430201 PMCID: PMC5796466 DOI: 10.2147/prom.s117771] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Pectus excavatum (PEx) is one of the most common congenital chest wall deformities. Depending on the severity, presentation of PEx may range from minor cosmetic issues to disabling cardiopulmonary symptoms. The effect of PEx on adult patients has not been extensively studied. Symptoms may not occur until the patient ages, and they may worsen over the years. More recent publications have implied that PEx may have significant cardiopulmonary implications and repair is of medical benefit. Adults presenting for PEx repair can undergo a successful repair with a minimally invasive "Nuss" approach. Resolution of symptoms, improved quality of life, and satisfying results are reported.
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Affiliation(s)
- MennatAllah M Ewais
- Department of Cardiothoracic Surgery, Mayo Clinic Hospital, Phoenix, AZ, USA
| | - Shivani Chaparala
- Department of Cardiothoracic Surgery, Mayo Clinic Hospital, Phoenix, AZ, USA
| | - Rebecca Uhl
- Department of Cardiothoracic Surgery, Mayo Clinic Hospital, Phoenix, AZ, USA
| | - Dawn E Jaroszewski
- Department of Cardiothoracic Surgery, Mayo Clinic Hospital, Phoenix, AZ, USA
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9
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Siniorakis E, Arvanitakis S, Tzevelekos P, Panta S, Balanis A, Aivalioti F, Limberi S. Pectus excavatum: Right ventricular compromise with orthostatic syndrome and Brugada phenocopy. J Saudi Heart Assoc 2017; 29:223-226. [PMID: 28652678 PMCID: PMC5475344 DOI: 10.1016/j.jsha.2017.01.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2016] [Revised: 12/06/2016] [Accepted: 01/23/2017] [Indexed: 11/30/2022] Open
Abstract
Pectus excavatum (PEXT) consists of an overgrowth of the chondral region with posterior displacement of the inferior part of the sternum, resulting in a concave chest deformity. Characteristic clinical and imaging findings may occur, depending on the compression that right cardiac chambers suffer, when squeezed between the sternum and the column vertebrae.
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Affiliation(s)
| | | | | | - Stamatia Panta
- Cardiology Department, Sotiria Chest Diseases Hospital, Athens, Greece
| | - Apostolos Balanis
- Cardiology Department, Sotiria Chest Diseases Hospital, Athens, Greece
| | - Fotini Aivalioti
- Cardiology Department, Sotiria Chest Diseases Hospital, Athens, Greece
| | - Sotiria Limberi
- Cardiology Department, Sotiria Chest Diseases Hospital, Athens, Greece
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10
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Maagaard M, Heiberg J. Improved cardiac function and exercise capacity following correction of pectus excavatum: a review of current literature. Ann Cardiothorac Surg 2016; 5:485-492. [PMID: 27747182 DOI: 10.21037/acs.2016.09.03] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Patients with pectus excavatum (PE) often describe improvements in exercise stamina following corrective surgery. Studies have investigated the surgical effect on physiological parameters; still, no consensus has yet been reached. Therefore, the aim of this literature review was to describe the cardiac outcome after surgical correction, both at rest and during exercise. In February 2016, a detailed search of the databases PubMed, Medline, and EMBASE was performed. We assessed clinical studies that described cardiac outcomes both before and after surgical correction of PE. We only included studies reporting either pre-defined echocardiographic or exercise test parameters. No exclusion criteria or statistical analyses were applied. Twenty-one full-text articles, published between 1972 and 2016, were selected, with cohort-ranges of 3-168 patients, mean age-ranges of 5-33 years, and mean follow-up-ranges from immediately to 4 years after surgery. Twelve studies described resting cardiac parameters. Four studies measured cardiac output, where one described 36% immediate increase after surgery, one reported 15% increase after Nuss-bar removal and two found no difference. Three studies demonstrated improvement in mean stroke volume ranges of 22-34% and two studies found no difference. Fifteen studies investigated exercise capacity, with 11 considering peak O2 pr. kg, where five studies demonstrated improvements with the mean ranging from 8% to 15% after surgery, five studies demonstrated no difference, and one saw a decrease of 19% 3 months after Nuss-bar implantation. A measurable increase in exercise capacity exists following surgery, which may be caused by multiple factors. This may be owed to the relief of compressed cardiac chambers with the increased anterior-posterior thoracic dimensions, which could facilitate an improved filling of the heart. With these results, the positive physiological impact of the surgery is emphasized and the potential gain in cardiac function should be integrated in the clinical assessment of patients with PE.
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Affiliation(s)
- Marie Maagaard
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Denmark
| | - Johan Heiberg
- Department of Cardiothoracic and Vascular Surgery, Aarhus University Hospital, Denmark
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11
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Pilegaard HK. Nuss technique in pectus excavatum: a mono-institutional experience. J Thorac Dis 2015; 7:S172-6. [PMID: 25984364 DOI: 10.3978/j.issn.2072-1439.2015.04.07] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2015] [Accepted: 03/27/2015] [Indexed: 11/14/2022]
Abstract
BACKGROUND Pectus excavatum (PE) is the most common anomaly of the anterior chest wall. Prior PE was corrected by a modified Ravitch operation, but since Nuss published his minimal technique in 1998, most surgeons have preferred this technique. METHODS Since 2001 the modified Nuss procedure has routinely been used for correction of more than 1,500 patients at Aarhus University Hospital. In the time period between January 1, 2011 and January 31, 2015, 675 patients have been corrected. The median age was 16 years (range, 11-58 years). All patients had preoperatively an epidural catheter and the operations were done in general anaesthesia. The postoperative pain treatment was planned for 4-5 weeks and the patients were routinely seen in the outpatient clinic 6 weeks after surgery and the bars removed after 3 years. RESULTS Four hundred-and-fifty patients had one bar, 216 patients with two bars and nine patients with three bars inserted. The median length of the bar was 10 inch. The median duration of the operation was 29 minutes. The median postoperative stay was 3 days. No death, cardiac perforation or deep infection occurred and only 5% of the patients experienced a complication. CONCLUSIONS The Nuss procedure should still be considered in the treatment of PE. To my opinion, it should be the choice for correction of PE. The short bar should be used to achieve the best stability of the system, to obtain a good cosmetic result, a reduced dysfunction motion of the chest wall and an increased cardiac performance.
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Affiliation(s)
- Hans K Pilegaard
- Department of Cardiothoracic and Vascular Surgery, Institute of Clinical Medicine, Aarhus University Hospital, Denmark
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