Mathematical calculation and coefficient value of chest shape recovery for planning thoracoplasty of pectus excavatum

Background. Pectus excavatum is characterized by retraction of the sternum and anterior ribs of different depth and width. The formation, its prediction, calculation of chest deformity, and their study when planning thoracoplasty using the Nuss procedure for this pathology is an important problem of orthopedics and thoracic surgery. The purpose of the work was to calculate the coefficient of restoration of the chest shape by the ratio of the pectus excavatum depth and the chest size in the frontal plane before and after mathematical modeling of thoracoplasty using the Nuss procedure. Methods. To assess displacement of ribs depen-ding on depth deformity of chest h, two models were built. The first model is a flat frame on supports, the elements of which consist of cartilaginous parts of ribs and sternum. For this model, the dependence of the force F was determined, which is necessary to correct the depth of chest deformity. The second model is a curved bar that simulates a rib, to one of the ends of which a support load is applied, calculated during the analysis of the first model. For this model, the displacement of the plate fixation point under the action of a given force was determined. To obtain more accurate results, a finite element study was performed on a chest model. Results. The correction of pectus excavatum depth without fixing plate to ribs was simulated. The displacements of rib sections in the place of plate fixation at different depths of pectus excavatum was assessed: h = 2 cm, h = 3 cm, h = 4 cm, h = 5 cm. The analysis of calculation results showed that after correction of the depth of chest deformity, its size in the frontal plane decreases. So, at the maximum deformation depth h = 5 cm, the deviation of the rib sections at the plate fixation point occurred by 2.4 cm. Conclusions. The relationship between the pectus excavatum depth and chest size in the frontal plane was established when modeling the newly formed chest form during for Nuss procedure. The coefficient of restoring the chest shape was mathematically calculated, which is 2 (2∆ = h), where h is the depth of pectus excavatum. The practical significance of the coefficient is that when planning thoracoplasty and shaping plate, the distance between its lateral ends, which corresponds to the chest shape and adjoin ribs, must be reduced by ½ h (where h is the depth of pectus excavatum) before correcting the pectus excavatum full adherence to the ribs in the postoperative period.

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Impact of pectus excavatum on pulmonary function before and after repair with the Nuss procedure

Journal of Pediatric Surgery ◽

10.1016/j.jpedsurg.2004.09.040 ◽

2005 ◽

Vol 40 (1) ◽

pp. 174-180 ◽

Cited By ~ 86

Author(s):

M. Louise Lawson ◽

Robert B. Mellins ◽

Meredith Tabangin ◽

Robert E. Kelly ◽

Daniel P. Croitoru ◽

...

Keyword(s):

Pulmonary Function ◽

Pectus Excavatum ◽

Nuss Procedure ◽

Before And After

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Minimal invasive surgical correction of pectus excavatum deformities in adolescents: Our institutional experience

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1308503j ◽

2013 ◽

Vol 141 (7-8) ◽

pp. 503-506

Author(s):

Radoica Jokic ◽

Dragan Kravarusic ◽

Milos Pajic ◽

Jelena Antic ◽

Zoran Vukasinovic

Keyword(s):

Pectus Excavatum ◽

Operative Time ◽

Postoperative Recovery ◽

Metal Plate ◽

Minimal Invasive ◽

Nuss Procedure ◽

Chest Deformity ◽

Institutional Experience ◽

Pectus Bar ◽

Invasive Surgical Approach

Introduction. Nuss procedure is a minimal invasive surgical technique based on retrosternal placement of a metal plate to correct pectus excavatum chest deformity. We are presenting our five?year (2006?2011) institutional experience of 21 patients. Objective. The aim of this study was to determine characteristics and advantages of minimal invasive surgical approach in correcting deformities of the chest. Methods. Surgical procedure, named after its author Nuss, involves the surgical placement of a molded metal plate, the so?called pectus bar, behind the sternum under thoracoscopic view whereby immediate controlled intraoperative corrections and stabilizations of the depression can be made. The great advantage of this method is reflected in a significant shortening of operative time, usually without indications for compensation in blood volume, and with a significantly shortened postoperative recovery that allows patients to quickly return to their normal activities. Results. In the period 2006?2011, 21 patients were operated by the Nuss procedure. The pectus bar was set in front or behind the muscles of the chest. Among the complications listed were inflammation of wounds in three patients, dislocation (shifting) of the bar requiring a reoperation in two patients, an occurrence of a pericardial effusion in one patient, and allergic response to foreign body in one patient. Five patients required extraction of the bar two years later, and three patients after three years, all with excellent results. Conclusion. Minimally invasive Nuss procedure is safe and effective. It currently represents the primary method of choice for solving the chest deformity pectus excavatum for patients of all ages. Modification of thoracoscopic control allows a safe field of operation. Postoperative results are excellent with very few complications that can be attributed to the learning curve.

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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

European Heart Journal ◽

10.1093/ehjci/ehaa946.3215 ◽

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 >1 mm deep and >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<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<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<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

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Exercise performance testing in patients with pectus excavatum before and after Nuss procedure

Pediatric Surgery International ◽

10.1007/s00383-010-2627-0 ◽

2010 ◽

Vol 26 (7) ◽

pp. 659-663 ◽

Cited By ~ 21

Author(s):

Christoph Castellani ◽

J. Windhaber ◽

P. H. Schober ◽

M. E. Hoellwarth

Keyword(s):

Exercise Performance ◽

Pectus Excavatum ◽

Performance Testing ◽

Nuss Procedure ◽

Before And After

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Pulmonary function before and after the Nuss procedure in adolescents with pectus excavatum: correlation with morphological subtypes

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-015-0236-7 ◽

2015 ◽

Vol 10 (1) ◽

Cited By ~ 7

Author(s):

Jin Yong Jeong ◽

Joong Hyun Ahn ◽

Sang Yong Kim ◽

Yoon Hong Chun ◽

Kyungdo Han ◽

...

Keyword(s):

Pulmonary Function ◽

Pectus Excavatum ◽

Nuss Procedure ◽

Before And After

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Improvement in Polysomnographic Objective Sleep Quality in Adults with Pectus Excavatum After the Nuss Procedure

World Journal of Surgery ◽

10.1007/s00268-019-05311-5 ◽

2019 ◽

Vol 44 (4) ◽

pp. 1316-1322

Author(s):

Mei-Chen Yang ◽

Chou-Chin Lan ◽

Yao-Kuang Wu ◽

Min-Shiau Hsieh ◽

Bo-Chun Wei ◽

...

Keyword(s):

Quality Of Life ◽

Sleep Quality ◽

Pectus Excavatum ◽

Nuss Procedure ◽

Subjective Sleep Quality ◽

Median Percentage ◽

Subjective Sleep ◽

Arousal Index ◽

Before And After

Abstract Background Patients with pectus excavatum have a poorer subjective sleep quality and quality of life than the general population. The Nuss procedure has been shown to improve these patients’ quality of life, but data regarding their postoperative sleep quality are lacking. We aimed to evaluate the objective sleep quality of adults with pectus excavatum before and after the Nuss procedure. Methods Twenty-eight participants completed this study. Epworth Sleepiness Scale (ESS) scores for daytime sleepiness, Pittsburgh Sleep Quality Index (PSQI) scores for subjective sleep quality, and overnight polysomnography for objective sleep quality were evaluated before and 6 months after the Nuss procedure. Results Subjective sleep quality improved after the Nuss procedure. The median PSQI score decreased from 7 [interquartile range (IQR): 5; 9] to 5 (IQR: 4; 7, p = 0.029); the median percentage of poor PSQI sleep quality decreased from 64.3 to 35.7% (p = 0.048). The median percentage of rapid eye movement sleep significantly increased after surgery [15.6% (IQR: 12.2%; 19.8%) vs. 20.4% (IQR: 14.5%; 24.9%), p = 0.016]. Sleep interruptions also improved, with the median arousal index decreasing from 9.5 (IQR: 4.8; 18.2) to 8.2 (IQR: 4.3; 12.1; p = 0.045). However, there was no significant change in ESS scores after surgery (p = 0.955). Conclusions Pectus excavatum may be associated with poor subjective and objective sleep quality in adults, and the condition may improve after the Nuss procedure. For adults with pectus excavatum who report poor subjective sleep quality, polysomnography should be considered to assess their preoperative and postoperative sleep condition.

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Reduced Myocardial Strain Parameters in Subjects With Pectus Excavatum: Impaired Myocardial Function or Methodological Limitations Due to Chest Deformity?

Seminars in Thoracic and Cardiovascular Surgery ◽

10.1053/j.semtcvs.2020.05.003 ◽

2020 ◽

Author(s):

Andrea Sonaglioni ◽

Gian Luigi Nicolosi ◽

Alberto Granato ◽

Michele Lombardo ◽

Claudio Anzà ◽

...

Keyword(s):

Pectus Excavatum ◽

Myocardial Function ◽

Myocardial Strain ◽

Chest Deformity

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The model and simulation of low impact development of the sponge airport, China

Water Science & Technology Water Supply ◽

10.2166/ws.2019.170 ◽

2019 ◽

Vol 20 (2) ◽

pp. 383-394 ◽

Cited By ~ 2

Author(s):

Jing Peng ◽

Jiayi Ouyang ◽

Lei Yu ◽

Xinchen Wu

Keyword(s):

Flood Control ◽

Low Impact Development ◽

Water Environment ◽

Drainage System ◽

Practical Significance ◽

International Airport ◽

Model And Simulation ◽

Impervious Area ◽

Before And After ◽

Airport Runway

Abstract Recently urban waterlogging problems have become more and more serious, and the construction of an airport runway makes the impervious area of the airport high, which leads to the deterioration of the water environment and frequent waterlogging disasters. It is of great significance to design and construct the sponge airport with low impact development (LID) facilities. In this paper, we take catchment N1 of Beijing Daxing International Airport as a case study. The LID facilities are designed and the runoff process of a heavy rainfall in catchment N1 is simulated before and after the implementation of LID facilities. The results show that the total amount of surface runoff, the number of overflow junctions and full-flow conduits of the rainwater drainage system in catchment N1 of Beijing Daxing International Airport are significantly reduced after the implementation of the LID facilities. Therefore, the application of LID facilities has greatly improved the ability of the airport to remove rainwater and effectively alleviated the risk of waterlogging in the airport flight area. This study provides theoretical support for airport designers and managers to solve flood control and rainwater drainage problems and has vital practical significance.

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Right Ventricular Compression Mimicking Brugada-Like Electrocardiogram in a Patient with Recurrent Pectus Excavatum

Case Reports in Cardiology ◽

10.1155/2017/3047937 ◽

2017 ◽

Vol 2017 ◽

pp. 1-4

Author(s):

Jinhee Ahn ◽

Jong-Il Choi ◽

Jaemin Shim ◽

Sung Ho Lee ◽

Young-Hoon Kim

Keyword(s):

Pectus Excavatum ◽

Surgical Correction ◽

Mechanical Compression ◽

St Segment Elevation ◽

Skeletal Anomaly ◽

St Segment ◽

Chest Deformity ◽

The Right ◽

Electrocardiogram Ecg ◽

Benign Course

Pectus excavatum (PE), the most common skeletal anomaly of chest wall, sometimes requires a surgical correction but recurrent PE is not uncommon. PE usually has a benign course; however, this chest deformity may be associated with symptomatic tachyarrhythmias due to mechanical compression. We report a case of a patient with recurrent PE after surgical correction presenting with palpitation and electrocardiogram (ECG) showing ST-segment elevation on the right precordial leads, which could be mistaken for a Brugada syndrome (BrS).

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