P3448Influence of severity of pectus excavatum as indicated by the Haller Index on actual heart compression and ECG findings

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
N Funabashi ◽  
T Horikoshi ◽  
K Ozawa ◽  
Y Kobayashi
Keyword(s):  
Pectus Excavatum ◽  
Observer Agreement ◽  
P Wave ◽  
Axis Deviation ◽  
Sinus Arrhythmia ◽  
Dominant Type ◽  
Haller Index ◽  
Unenhanced Ct ◽  
Significant Difference ◽  
The Mean

Abstract Background Pectus excavatum (PEX) is a depression of the sternum relative to the costal cartilages. The Haller index (HI) is an anatomical indicator of the severity of PEX that is calculated from CT. Purpose We evaluated the influence of anatomical severity of PEX as indicated by HI on the severity of actual heart compression and ECG findings Methods A total of 28 patients (23 males; 20±19 years) with PEX underwent unenhanced CT and ECG. On CT, HI and degree of compression of right (RA) and left atria (LA) were evaluated simultaneously. Results As indicated by CT, the mean HI was 5.80±2.34. We observed 7, 15, 5, and 1 patient with none, mild, moderate, or severe RA compression, respectively. In addition, we observed 8, 13, 4, and 3 patients with none, mild, moderate, or severe LA compressions, respectively. The mean HI was calculated as 4.28±0.92, 5.40±2.01, 6.85±1.81, and 9.61±0.00 in patients with none, mild, moderate, or severe RA, respectively, and the findings were significant (P=0.021). The mean HI was calculated as 4.17±0.91, 5.97±2.23, 5.95±1.51, and 6.69±2.93 in patients with none, mild, moderate, or severe LA compression, respectively, although the findings were not significant (P=0.145). On ECG, a P wave with a negative portion >1 mm in depth and >40 ms in duration in the V1 lead, complete or incomplete right bundle branch block (RBBB), sinus arrhythmia, or right-axis deviation of a QRS wave were diagnosed in 23, 10, 8, and 6 patients, respectively. The HI between patients with (n=23) and without (n=5) a negative portion of the P wave in the V1 lead showed a significant difference (6.45±2.43 vs. 4.62±1.68; P<0.05). The correlation coefficient between absolute values of the maximum negative portion of the P wave in the V1 lead and HI was 0.36 (n=28). The HI between patients with and without a complete or incomplete RBBB showed a significant difference (6.98±2.43 vs. 5.14±2.07; P<0.05). The HI between patients with and without a sinus arrhythmia did not show a significant difference (5.45±2.66 vs. 5.94±2.25). The HI between patients with and without a right axis deviation on a QRS wave also did not show a significant difference (4.76±1.53 vs. 6.08±2.64). The inter-observer agreement of HI between the two observers was 0.978. Haller index and heart compression on CT Conclusion In patients with PEX, compression of RA on CT, a negative portion of the P wave in V1, complete or incomplete RBBB, sinus arrhythmia, and a right axis deviation on a QRS wave are common. The degree of compression of RA on CT, negative portion of the P wave in the V1 lead and complete or incomplete RBBB on ECG are associated with anatomical severity as indicated by the HI. However, our results showed that HI severity was unrelated to either the degree of compression of LA on CT, or sinus arrhythmia and right-axis deviation of the QRS wave on ECG. These observations may be due to variation of location of maximum sternum depression, such as high- or low-positioned dominant-type compressions.

Influence of Nuss surgical operation for pectus excavatum on electrocardiogram abnormality considering anatomical severity as indicated by Haller index acquired by computed tomography and age

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N Funabashi ◽  
Y Kobayashi
Keyword(s):  
Pectus Excavatum ◽  
Minimal Invasive ◽  
P Wave ◽  
Invasive Technique ◽  
Nuss Procedure ◽  
P Waves ◽  
Sinus Arrhythmia ◽  
Haller Index ◽  
Unenhanced Ct ◽  
Before And After

Abstract Background Pectus excavatum (PEX) is a depression of the sternum relative to costal cartilages and sometimes depress heart anatomically which cause abnormal ECG change. Nuss operation is minimal invasive technique for PEX repair. Purpose We speculated this Nuss operation would improve these ECG abnormalities. We also considered the Haller index (HI) and age to these influences. HI is an anatomical severity indicator of PEX calculated from CT. Methods A total of 17 patients (14 male, 12±6 years), who underwent Nuss operation for PEX, underwent unenhanced CT and ECG before and after the Nuss operation. Results All Nuss operation was successfully performed. On CT, HI was significantly improved from 5.62±2.29 to 3.29±0.65 (P=0.0002). A P wave with a negative portion &gt;1 mm deep and &gt;40 ms duration in V1 lead, incomplete right bundle branch block (RBBB), sinus arrhythmia, and right-axis deviation of a QRS wave were diagnosed in 15, 6, 12, and 5 patients, respectively. Comparing before with after Nuss operation, there were no significant differences of the degree of electrical axis of QRS waves, the degree of electrical axis of P waves, or the PQ interval, respectively (All P=NS). Absolute values of voltage of a negative portion of the P wave in V1 lead was significantly improved after the operation (1.55±1.25 vs 0.76±0.91mm, P&lt;0.001). Among 12 patients with sinus arrhythmia, only one patient improved to that without. Among 6 patients with incomplete RBBB, only one patient improved to that without. The correlation coefficient (CC) between “values of the improvement of negative portion of the P wave in V1 lead after the operation” and “HI before operation” was 0.305 (P&lt;0.05). The CC between “absolute values of the improvement of negative portion of the P wave in V1 lead after the operation” and “age at the operation” was −0.216 (P&lt;0.05). Conclusion In patients with PEX, successful Nuss operation could achieve improvement of negative portion of the P wave in V1 lead positively correlated with “HI before operation” and negatively correlated with “age”. Nuss procedure would be more effective to abnormal ECG change, when anatomical severity is severer or age is younger. Improvement of negative P wave Funding Acknowledgement Type of funding source: None

scholarly journals Comparison of electrocardiographic parameters of racing and non-racing horses in Sokoto Nigeria

2020 ◽  
Vol 18 (1) ◽  
pp. 33-38
Author(s):  
B. Saidu ◽  
A.J. Ishaq ◽  
H.M. Ibrahim ◽  
A. Dahiru ◽  
A.M. Abdullahi ◽  
...  
Keyword(s):  
Standing Position ◽  
P Wave ◽  
Average Weight ◽  
T Wave ◽  
Qt Intervals ◽  
Significant Difference ◽  
The Mean ◽  
Electrocardiographic Parameters ◽  
Electrical Activities ◽  
One Way Anova

The study was conducted due to the economic importance of horses and shortage of information on electrocardiographic parameters of horses in Sokoto, Nigeria. This study established the normal electrocardiographic parameters of racing and non-racing horses in Sokoto and statistically compared the values. The study used forty horses comprising of 20 racing and 20 non-racing horses with mean age of 8 ± 0.5 years and average weight of 200 ± 2.0 kg. ECG was recorded using the base apex system with the animals in standing position using single lead channel ECG recorder (EDAN VE-100 manufactured by Edan instruments China). The paper speed was set at 25mm/s while the sensitivity of the machine was adjusted to 10 mm/mV. The durations and amplitudes of P, R and T, the durations of Q and S and the durations of PR, QRS and QT intervals were all determined. These parameters were determined for the three standard limb leads (I, II and III) as well as the augmented limb leads (aVR, aVL and aVF). Descriptive statistics using SPSS version 16 was used to calculate the means and standard error of mean at 95 % confidence interval. One-way ANOVA was used to compare between the values of the racing and non-racing horses. The highest values of P amplitude, R amplitude, Q amplitude, QRS complex and P-R interval were recorded in racing horses, while highest T wave amplitude was recorded in non-racing horses. Highest duration of P wave, T wave and QRS was recorded in racing horses while highest duration of Q wave was recorded in non-racing horses. Significant difference was found in the T amplitude in racing horses in lead aVF. The mean heart rate for the racing and non-racing horses was 80.3 ± 8.4 and 63.1 ± 9.2 beats/minute respectively. Higher values recorded in racing horses indicates that exercise has influence on electrical activities in horses. Keywords: Electrocardiograph, Non-racing horses, Parameters, Racing horses, Sokoto

Abstract 13730: Electrical Axes of P and T but Not QRS Waves on ECG Are New Indicators of Successfulness of the Nuss Operation for Pectus Excavatum Considering Anatomical Severity as Indicated by the Haller Index Acquired by CT

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Nobusada FUNABASHI ◽  
Yoshio Kobayashi
Keyword(s):  
Pectus Excavatum ◽  
Correlation Coefficients ◽  
P Wave ◽  
Invasive Technique ◽  
P Waves ◽  
Haller Index ◽  
Before And After ◽  
Group 2 ◽  
Group 1 ◽  
T Waves

Introduction: Pectus excavatum (PEX) is a depression of the sternum which can physically constrict the heart and cause abnormal ECGs. The Nuss operation is a minimally invasive technique for PEX repair. Hypothesis: As right (RA) and left atria (LA) are compressed in PEX, axes of P, QRS, and T waves are abnormal and the Nuss operation normalizes them. We also took the Haller index (HI) into to account. Methods: 17 PEX patients (14 male, 12±6 years) underwent CT and ECG before and after the Nuss operation. Results: All Nuss operations were successful, and HI was significantly improved from 5.62±2.29 to 3.29±0.65 (P=0.0002). There were no significant differences before and after surgery for electrical axes of P waves (46±20 vs 65±55, P=0.20), and QRS waves (75±33 vs 76±23, P=0.72), but T waves were greater thereafter (22±27 vs 40±19, P=0.001). Correlation coefficients (CC) between the degree of axes of P, QRS and T waves, and HI before operation were -0.23, -0.06, and 0.11, respectively. These values after operation were -0.25, -0.06, and 0.19, respectively. As HI is an indirect indicator of heart compression, we evaluated the degree of RA and LA compression qualitatively as none, mild, and moderate/more. Of 17 patients, 5 had moderate/more compression of RA and/or LA by PEX (group 1); the remaining 12 did not show compression (group 2). Only P wave values were significantly smaller in group 1 than 2 before surgery, but these differences disappeared after surgery. In both groups, degree of axes of T waves was significantly greater after the operation. Conclusion: In patients with PEX, axes of T waves after the Nuss operation became significant greater than before the operation in patients with moderate or more compression of RA and/or LA by PEX. For P waves, this was smaller before the operation in those with compression but this was improved by the Nuss operation. P and T wave axes but not QRS could be therefore non-invasive indicators of Nuss operation success in addition to gross PEX appearance.

MIGRATION AS A DETERMINANT OF MARRIAGE PATTERN: PRELIMINARY REPORT ON CONSANGUINITY AMONG AFGHANS

2005 ◽  
Vol 38 (3) ◽  
pp. 315-325 ◽  
Author(s):  
ABDUL WAHAB ◽  
MAHMUD AHMAD ◽  
SYED AKRAM SHAH
Keyword(s):  
Preliminary Report ◽  
Marriage Pattern ◽  
Cousin Marriage ◽  
Dominant Type ◽  
Resident Population ◽  
Refugee Population ◽  
Consanguineous Marriages ◽  
Significant Difference ◽  
The Mean ◽  
Coefficient Of Inbreeding

Two sample populations, one refugee and one resident, were studied. The frequencies of consanguineous marriages came out to be 49·8% and 55·4%, respectively, for the refugees and the residents. Caste endogamy was dominant both in the residents and the refugees. The mean coefficient of inbreeding was calculated to be 0·0303 for the refugee population and 0·0332 for the resident population samples. First cousin marriage was the dominant type of marriage in both samples; father’s brother’s daughter (FBD) marriage was more frequent among the refugees while mother’s brother’s daughter (MBD) marriage was more frequent among the residents. Education has no decreasing effect on the incidence of consanguineous marriages. A significant difference in the pattern of marriages in the refugees is observed after the Saur Revolution of 1979.

scholarly journals Radiological changes after Nuss operation for pectus excavatum

Medicina ◽  
2009 ◽  
Vol 45 (9) ◽  
pp. 699 ◽  
Author(s):  
Artūras Kilda ◽  
Saulius Lukoševičius ◽  
Vidmantas Barauskas ◽  
Živilė Jankauskaitė ◽  
Algidas Basevičius
Keyword(s):  
Chest Wall ◽  
Pectus Excavatum ◽  
First Year ◽  
Nuss Procedure ◽  
Funnel Chest ◽  
Haller Index ◽  
Wall Deformation ◽  
Lateral Chest ◽  
Radiological Changes ◽  
The Mean

The objective of this study was to evaluate sternovertebral distance and the chest wall deformation after Nuss procedure. Materials and methods. Anteroposterior and lateral chest radiographs were performed before Nuss procedure, 1, 6, and 12 months after operation and finally 1 month after bar removal. Sternovertebral distance and transversal chest dimension were measured on radiographs, as well as Haller and vertebral indexes were calculated. Results. A total of 84 children with funnel chest were operated on. Preoperative sternovertebral distance was 79.81±6.96 mm; 1 month after operation, 97.84±17.08 mm; 6 months, 110.55±13.85 mm; and 12 months, 113.6±14.61 mm. After removal of the bar, the distance was 105±11.95 mm. The mean increase in sternovertebral distance during the first month was 18 mm (P<0.0001); 1–6 months, 12.8 mm (P=0.0006); and 6-12 months, 3 mm (P=0.48). The mean decrease in sternovertebral distance after removal of the bar was 8.6 mm (P=0.47). The decrease in transversal chest dimension during the first month was significant (13.3±12.86 mm, P=0.012). Conclusions. The sternovertebral distance was significantly increased after Nuss operation. Restoration of deformation proceeds during all the first year after operation. The dynamics of deformation is better depicted by means of vertebral index rather than Haller index.

scholarly journals Clinical and histopathological features of myocarditis in dogs with visceral leishmaniasis

2015 ◽  
Vol 67 (6) ◽  
pp. 1519-1527 ◽  
Author(s):  
F.P. dos Santos ◽  
J.P.E. Pascon ◽  
D.T.P. Pereira ◽  
B.L. Anjos ◽  
M.L.A. Mistieri ◽  
...  
Keyword(s):  
Visceral Leishmaniasis ◽  
P Wave ◽  
Control Group ◽  
Sinus Arrhythmia ◽  
Mean Values ◽  
Group A ◽  
Electrocardiographic Changes ◽  
The Mean ◽  
Radiographic Changes ◽  
Myocardial Lesions

Visceral leishmaniasis (VL) is a cosmopolitan parasitic zoonosis that can promote myocarditis and heart rate changes in canine and human hosts. Thus, histopathological aspects of the myocardium and clinical, hematological, biochemical, radiological and electrocardiographic data were evaluated in a group of 36 dogs naturally infected with VL (VLG) and compared to data from 15 non-infected dogs (CG=Control Group). A prevalence of asymptomatic dogs was present in the CG (100%) and polysymptomatic dogs in the VLG (66%). In addition, two dogs in the VLG demonstrated systolic murmurs in the mitral valve region: one with a II/VI intensity and the other with a III/VI intensity. The mean values of RBC, hemoglobin and hematocrit were lower in dogs in VLG and were associated with higher values of total protein, total leukocytes, neutrophils, creatine kinase overall (CK) and the CK-MB fraction (CK-MB). The absence of radiographic changes was accompanied by a predominance of respiratory sinus arrhythmia associated with episodes of migratory pacemaker and sinus arrest in dogs in VLG (75%), sinus rhythm in dogs in CG (60%) and decreased P wave amplitude in VLG electrocardiography. Mononuclear cell infiltration was detected in the myocardium of 77,8% of dogs in GVL and classified primarily as mild multifocal lymphohistioplasmacytic. Amastigotes were detected in only one dog, which did not allow the association between myocarditis and parasitism, although the myocardial lesions that were found constitute irrefutable evidence of myocarditis in the VLG dogs, accompanied by lenient electrocardiographic changes compared to CG.

Repetitive Imaging following Minimally Invasive Repair of Pectus Excavatum Is Unnecessary

2018 ◽  
Vol 29 (05) ◽  
pp. 408-411 ◽  
Author(s):  
Richard Sola ◽  
Yangyang R. Yu ◽  
Tyler C. Friske ◽  
Abdur R. Jamal ◽  
Eric H. Rosenfeld ◽  
...  
Keyword(s):  
Minimally Invasive ◽  
Clinical Outcomes ◽  
Pectus Excavatum ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Tube Placement ◽  
Haller Index ◽  
Significant Difference ◽  
Repeat Imaging

Introduction The objective of this study was to evaluate the necessity of repeat imaging after an initial chest radiograph (CXR) following minimally invasive repair of pectus excavatum (MIRPE). Materials and Methods A retrospective review was performed on patients who underwent MIRPE from January 2012 to July 2016 at two academic children's hospitals. Data collected included demographics, severity of pectus defect (Haller index [HI]), utilization of CXRs, outpatient follow-up, and clinical outcomes. Results A total of 360 patients (171 at Hospital 1 and 189 at Hospital 2) underwent MIRPE. Median age was 15.6 years and 84% were males. The median HI was 4.0. Median postoperative hospital length of stay was 4.2 days and median time to bar removal was 34 months. There was significant variation in postoperative imaging between the hospitals, including frequency of immediate postoperative CXR, total number of CXRs during hospitalization, and number of postoperative outpatient CXRs prior to bar removal. However, there was no significant difference in outcomes between the hospitals, including postoperative pneumothorax, postoperative chest tube placement, and complications. Conclusion These data suggest that increased repetitive imaging after an initial postoperative CXR does not affect clinical outcomes and may not be necessary after MIRPE.

scholarly journals Overstuffing in resurfacing hemiarthroplasty is a potential risk for failure

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Pieter C. Geervliet ◽  
Jore H. Willems ◽  
Inger N. Sierevelt ◽  
Cornelis P. J. Visser ◽  
Arthur van Noort
Keyword(s):  
Observer Agreement ◽  
Post Surgery ◽  
Orthopedic Surgeons ◽  
Institutional Review ◽  
Inter Observer Variability ◽  
Significant Difference ◽  
The Mean ◽  
The Difference ◽  
End Stage ◽  
Shoulder Angle

Abstract Purpose Literature describes the concern of an overstuffed shoulder joint after a resurfacing humeral head implant (RHHI). The purpose of this study was to evaluate inter-observer variability of (1) the critical shoulder angle (CSA), (2) the length of the gleno-humeral offset (LGHO), and (3) the anatomic center of rotation (COR) in a patient population operated with a Global Conservative Anatomic Prosthesis (CAP) RHHI. The measurements were compared between the revision and non-revision groups to find predictive indicators for failure. Methods Pre- and postoperative radiographs were retrieved from 48 patients who underwent RHHI from 2007 to 2009 using a Global CAP hemiarthroplasty for end-stage osteoarthritis. This cohort consisted of 36 females (12 men) with a mean age of 77 years (SD 7.5). Two musculoskeletal radiologist and two specialized shoulder orthopedic surgeons measured the CSA, LGHO, and COR of all patients. Results The inter-observer reliability showed excellent reliability for the CSA, LGHO, and the COR, varying between 0.91 and 0.98. The mean COR of the non-revision group was 4.9 mm (SD 2.5) compared to mean COR of the revision group, 8 mm (SD 2.2) (p < 0.01). The COR is the predictor of failure (OR 1.90 (95%Cl 1.19–3.02)) with a cut of point of 5.8 mm. The mean CSA was 29.8° (SD 3.9) There was no significant difference between the revision and non-revision groups (p = 0.34). The mean LGHO was 2.6 mm (SD 3.3) post-surgery. The mean LGHO of the revision group was 3.9 (SD 1.7) (p = 0.04) post-surgery. Despite the difference in mean LGHO, this is not a predictor for failure. Conclusion The CSA, LGHO, and COR can be used on radiographs and have a high inter-observer agreement. In contrast with the CSA and LGHO, we found a correlation between clinical failure and revision surgery in case of a deviation of the COR greater than 5 mm. Trial registration Institutional review board, number: ACLU 2016.0054, Ethical Committee number: CBP M1330348. Registered 7 November 2006.

scholarly journals Is Pectus Excavatum a Risk Factor for Spontaneous Pneumothorax? “Haller Index Measurements in Patients with Primary Spontaneous Pneumothorax”

2019 ◽  
Vol 2019 ◽  
pp. 1-5 ◽  
Author(s):  
Ali Kılıçgün ◽  
Osman Yakşi ◽  
Mehmet Ünal
Keyword(s):  
Risk Factor ◽  
Pectus Excavatum ◽  
Spontaneous Pneumothorax ◽  
Primary Spontaneous Pneumothorax ◽  
Control Group ◽  
Haller Index ◽  
Group I ◽  
Significant Difference ◽  
Patient Groups ◽  
Group Ii

Aim. In this study, we aimed to retrospectively investigate whether pectus excavatum (PE) is a risk factor for the development of primary spontaneous pneumothorax (PSP) and to determine its role in the etiology of the disease. Materials and Methods. Chest-computed tomography (CT) of the patients who were treated for spontaneous pneumothorax between January 2015 and December 2017 in our clinic was examined, and their Haller indices were measured (group I). The patients in the control group who underwent chest CT for other reasons during the same period and were in the same age with the group I were also included in the study (group II) Results. In group I, for patients with PE, the mean Haller index was 2.41, while it was 2.09 in the control group (group II). There was a significant difference between the two groups. Conclusions. PE deformities in the chest wall may predispose to the development of spontaneous pneumothorax, and PE may be among the etiologic factors of spontaneous pneumothorax. Therefore, there is a need for studies involving larger patient groups.

810 REPRODUCIBILITY OF REPEATED MEASUREMENTS OF OESOPHAGEAL MOTILITY METRICS WITHIN A STUDY

2021 ◽  
Vol 34 (Supplement_1) ◽  
Author(s):  
Sergey Morozov ◽  
Vasily Kropochev ◽  
Alexey Artemov
Keyword(s):  
Repeated Measurements ◽  
Observer Agreement ◽  
Functional Tests ◽  
Oesophageal Motility ◽  
Additional Time ◽  
Significant Difference ◽  
Different Types ◽  
Parametric Statistics ◽  
The Mean ◽  
Integrated Relaxation Pressure

Abstract   To compare reproducibility of repeated measurements of oesophageal motility metrics after 5 wet swallows within a study. Methods Patients referred for high-resolution esophageal manometry (HREM) to assess oesophageal motor function were enrolled. Solid-state 36-channel 10 Fr catheter (Unisensor AG) and Solar (MMS) software were used. Minimum 10 water swallows by 5 mL each were obtained. Two operators independently assessed the results of examination. Records of swallows were divided into 2 series by 5 measurements each. These series were compared by key metrics: integrated relaxation pressure (IRP), distal contractile integral (DCI), distal latency (DL), and contractile front velocity (CFV). Non-parametric statistics was used to compare the results. Results We enrolled 46 men and 68 women, age (mean ± SD) 48.8 ± 11.5 y.o. Of them, 52 patients had GERD, 25-different types of achalasia and 37 had no oesophageal disorders. The inter-observer agreement between 2 series of measurements reached 98%. No significant difference was found between the mean results of IRP, DCI, DL and CFV in 2 series of measurements (table 1). Conclusion No significant differences between studied HREM metrics in two series of measurements were found. The results of two series by 5 measurements within a study are reproducible. This may indicate the possibility of reducing the standard number of measurements. Reduction of time necessary for standard examination may allow additional time for functional tests (solid food swallows, RDC or MRS).

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