Pectus Excavatum and Pectus Carinatum: Associated Conditions, Family History, and Postoperative Patient Satisfaction (original) (raw)
Related papers
Pectus Excavatum: Consensus and Controversies in Clinical Practice
The Annals of Thoracic Surgery, 2023
BACKGROUND Pectus excavatum is the most common congenital anterior chest wall deformity. Currently, a wide variety of diagnostic protocols and criteria for corrective surgery are being used. Their use is predominantly based on local preferences and experience. To date, no guideline is available, introducing heterogeneity of care as observed in current daily practice. The aim of this study was to evaluate consensus and controversies regarding the diagnostic protocol, indications for surgical correction, and postoperative evaluation of pectus excavatum. METHODS The study consisted of 3 consecutive survey rounds evaluating agreement on different statements regarding pectus excavatum care. Consensus was achieved if at least 70% of participants provided a concurring opinion. RESULTS All 3 rounds were completed by 57 participants (18% response rate). Consensus was achieved on 18 of 62 statements (29%). Regarding the diagnostic protocol, participants agreed to routinely include conventional photography. In the presence of cardiac impairment, electrocardiography and echocardiography were indicated. Upon suspicion of pulmonary impairment, spirometry was recommended. In addition, consensus was reached on the indications for corrective surgery, including symptomatic pectus excavatum and progression. Participants moreover agreed that a plain chest radiograph must be acquired directly after surgery, whereas conventional photography and physical examination should both be part of routine postoperative follow-up. CONCLUSIONS Through a multiround survey, international consensus was formed on multiple topics to aid standardization of pectus excavatum care.
Outcome of surgical repair of Pectus Excavatum in adults
Journal of Cardiothoracic Surgery, 2017
Background: Pectus Excavatum (PEx) is the most common congenital chest wall deformity, accounting for over 90% of all chest wall deformities. Surgical correction is recommended because severe PEx can affect the physical and psychological development of patients. The aim of our study was to assess the impact of surgical repair of Pectus Excavatum in adults during hospital course and results after 1 year. Methods: Prospective study was carried out on 86 adult patients aged ≥ 15 years, 52 males and 34 females (mean age was 26 ± 1.5 years). All cases were divided into two groups, group I: (15-25 years old) and group II: (> 25 years old). Preoperative, operative, and postoperative data were reviewed. Statistical analysis was performed. Results: Statistical analyses revealed significant improvement postoperatively of cosmetic satisfaction (P-value < 0. 0001), pain (P-value =0.0003), exertional dyspnea (p-value <0.05) and exercise tolerance. The degree of chest compression was significantly improved after surgical correction within 12 months and the estimated measurement postoperatively of Haller Index showed significant reduction (p-value <0.001). Patient satisfaction postoperatively was excellent in 77.9% of all cases. Conclusion: Surgical correction of Pectus Excavatum using open technique in adults had excellent post-operative outcome in the short term follow up that encourage performing the procedure for all cases. Long term results need longer period for follow up. Etiology and predisposing factors still need further research.
PLOS ONE, 2020
Background Pectus excavatum is the most common chest wall skeletal deformity. Although commonly evaluated in adolescence, its prevalence in adults is unknown. Methods and findings Radiographic indices of chest wall shape were analyzed for participants of the first (n = 2687) and second (n = 1780) phases of the population-based Dallas Heart Study and compared to clinical cases of pectus (n = 297). Thoracic computed tomography imaging studies were examined to calculate the Haller index, a measure of thoracic axial shape, and the Correction index, which quantitates the posterior displacement of the sternum relative to the ribs. At the level of the superior xiphoid, 0.5%, 5% and 0.4% of adult Dallas Heart Study subjects have evidence of pectus excavatum using thresholds of Haller index >3.25, Correction index >10%, or both, respectively. Radiographic measures of pectus are more common in females than males and there is a greater prevalence of pectus in women than men. In the general population, the Haller and Correction indices are associated with height and weight, independent of age, gender, and ethnicity. Repeat imaging of a subset of subjects (n = 992) demonstrated decreases in the mean Haller and Correction indices over seven years, suggesting change to a more circular axial thorax, with less sternal depression, over time. Conclusions To our knowledge, this is the first study estimating the prevalence of pectus in an unselected adult population. Despite the higher reported prevalence of pectus cases in adolescent boys, this study demonstrates a higher prevalence of radiographic indices of pectus in adult females.
Quality of life improves after minimally invasive repair of pectus excavatum
Asian cardiovascular & thoracic annals, 2015
Background: Pectus excavatum is the most common chest wall deformity. This deformity may cause physical limitations and psychosocial problems. In this study, we aimed to investigate the effect of minimally invasive repair of pectus excavatum on the quality of life. Methods: This study included 88 patients, aged 18.44 AE 3.93 years (85.2% male), who underwent minimally invasive repair of pectus excavatum; 40.9% had an associated anomaly or disease, and 17.0% had scoliosis. The patients and their parents completed the patient and parent forms of the Nuss questionnaire modified for adults preoperatively and 6 months after the operation. Results: The patients' median Nuss score increased from 31 (interquartile range 31-35) preoperatively to 43 (interquartile range 43-46) at 6 months after the operation (p ¼ 0.000). The parents' preoperative score of 33 (interquartile range 29-36) increased to 38 (interquartile range 34-41; p ¼ 0.000). Improvements in the physical and psychosocial component scores of the Nuss questionnaire were also significant in the patient (p ¼ 0.000, p ¼ 0.000, respectively) and parent forms (p ¼ 0.005, p ¼ 0.000, respectively). Conclusions: Minimally invasive repair of pectus excavatum significantly improved the physical and psychosocial wellbeing of patients. Longitudinal studies are needed to determine the long-term changes related to quality of life.
[Minimally invasive correction of pectus excavatum among adults. Report of eighteen cases]
2009
BACKGROUND A minimally invasive technique or Nuss procedure was devised for children with pectus excavatum (funnel chest), but it is also used in adult patients. AIM To report the experience with the Nuss procedure in adults' patients with pectus excavatum. MATERIAL AND METHODS Prospective study of patients operated between January 2007 and January 2009. Clinical features, symptoms, operative time, postoperative complications, hospital stay and quality of life, using the Nuss questionnaire adapted for adults, was recorded. RESULTS Eighteen patients aged 18+/-2 years (14 males) were operated. Seven patients had scoliosis, two had depression, two had asthma and one had a Marfan syndrome. AU patients were concerned about aesthetic issues, nine had dyspnea, three had compression of cardiac cavities and three had pulmonary function disturbances. Haller index was 3.8. Mean operative time was 92 minutes. Postoperative complications were a pneumothorax without chest tube management in t...
Early experience of minimally invasive repair of pectus excavatum in RIPAS Hospital
2012
Introduction: Pectus excavatum (PE) commonly known as sunken chest or funnel chest, is a congenital deformity of the anterior chest wall and is the commonest of all congenital chest wall abnormalities. It can be associated with physical and psychological morbidity. This study evaluates our unit’s experience in performing minimally invasive repair of PE (MIRPE) surgery, also known as “NUSS repair” in teenage patients with PE in RIPAS Hospital. Materials and Methods: Retrospective data analysis of the first seven cases of MIRPE performed at RIPAS Hospital since November 2011, when our MIRPE service was first introduced. Patients’ demographic and operative records of all the cases were retrieved from the Department of Surgery Operation Note database and medical notes. Results: There were five males and one female with a mean age of 17 ± 2.3 years (14.6 – 20.7 years) at the time of repair. The mean Haller index, left ventricular ejection fraction, forced expiratory volume in one second ...
The Correction Index: Setting the Standard for Recommending Operative Repair of Pectus Excavatum
The Annals of Thoracic Surgery, 2014
Background. The Haller index, derived from a chest computed tomography scan, remains the standard for determining candidacy for pectus excavatum repair (Haller index ‡3.25). However, it has been suggested that this index may not accurately reflect pectus severity in patients with abnormal chest wall morphologies. This study explores a new, more appropriate criteria for recommending repair based on a correction index, while still incorporating the standard set by the Haller index.