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 Is vacuum bell therapy effective in the correction of pectus excavatum?

2019 ◽  
Vol 29 (2) ◽  
pp. 287-290 ◽  
Author(s):  
Akshay J Patel ◽  
Ian Hunt
Keyword(s):  
Chest Wall ◽  
Pectus Excavatum ◽  
Significant Heterogeneity ◽  
Nuss Procedure ◽  
Soft Tissue Dissection ◽  
Computed Tomography Scanning ◽  
Wall Flexibility ◽  
Clinical Questions ◽  
Study Type

Abstract A best evidence topic in thoracic surgery was written in accordance to a structured protocol. The question addressed was: ‘In patients with a pectus excavatum deformity, is vacuum bell therapy (VBT) an effective treatment?’ Altogether, 19 papers were found using the reported search of which 7 represented the best evidence to answer the clinical questions. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. Numerous groups have demonstrated the utility of VBT in pectus excavatum; the largest series has followed up patients over 13 years with sternal elevation of >1 cm being demonstrated in 105 patients. Initial age <11, initial chest wall depth <1.5 cm and chest wall flexibility have all been associated with better outcomes. The effects of VBT have been confirmed on computed tomography scanning and intraoperatively to lift the sternum to facilitate retrosternal soft tissue dissection during the Nuss procedure. There was significant heterogeneity in the studies reviewed, in terms of patient age, selection criteria, the VBT protocol, length of follow-up time following completion of VBT and the metrics used to assess success of therapy. VBT is a safe therapy for treating pectus excavatum in a non-surgical conservative manner with few complications reported. However, the success of VBT is largely dependent on patient compliance and motivation. Permanence of correction after completion of VBT needs to be properly assessed through rigorous follow-up, and currently the success of correction, i.e. permanence, remains in the hands of the patient.

Effects of the Nuss procedure on chest wall kinematics in adolescents with pectus excavatum

2012 ◽  
Vol 183 (2) ◽  
pp. 122-127 ◽  
Author(s):  
B. Binazzi ◽  
G. Innocenti Bruni ◽  
F. Gigliotti ◽  
C. Coli ◽  
I. Romagnoli ◽  
...  
Keyword(s):  
Chest Wall ◽  
Pectus Excavatum ◽  
Nuss Procedure ◽  
Chest Wall Kinematics

scholarly journals A Retrospective Study on the Impact of Bar Flipping on the Recurrence of Pectus Excavatum after the Nuss Procedure

2021 ◽  
Author(s):  
Yu-Jiun Fan ◽  
Po-Cheng Lo ◽  
Yuan-Yu Hsu ◽  
I-Shiang Tzeng ◽  
Bo-Chun Wei ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Pectus Excavatum ◽  
Slope Angle ◽  
Chest Radiographs ◽  
The Other ◽  
Nuss Procedure ◽  
Patient Groups ◽  
Lateral Chest ◽  
The Impact ◽  
Improvement Index

Abstract BackgroundThe Nuss procedure is widely used to correct pectus excavatum. Bar displacement is a common complication associated with this procedure. How the flipping of the bar affects pectus excavatum recurrence has not been reported. In our study, we discuss this and also offer an easier method to determine bar flipping.MethodsThis retrospective study analyzed pectus excavatum patients who underwent primary Nuss repair from August 2014 to December 2018. The preoperative and postoperative Haller indices were measured on chest radiographs (cxrHI). The slope angle of bar flipping (α) was measured on lateral chest radiographs. The improvement index after surgical repair was calculated by: ([preoperative cxrHI-postoperative cxrHI]/preoperative cxrHI×100). The impact of α on the improvement index was analyzed using one-way analysis of variance and receiver operating characteristic tests.ResultsIn this study, 359 adult and adolescent patients with an average age of 23.9±7.7 years were included. We formed four subgroups based on the α value: α ≤ 10° (n=131), α = 11-20° (n=154), α = 21-30° (n=51), and α > 30° (n=23). The mean improvement indices in these groups were 27%, 28%, 26%, and 13%, respectively. Patients with α > 30° were associated with a significantly poorer improvement index than those from the other subgroups (p<0.001).ConclusionsThe α value is an alternative measurement method for presenting the radiological outcomes after the Nuss procedure. An α > 30° indicates a possible recurrence of pectus excavatum after the Nuss repair. Surgical revision may be considered in patients with an α > 30°, while monitoring should be considered in the other patient groups.

scholarly journals A retrospective study on the impact of bar flipping on the recurrence of pectus excavatum after the Nuss procedure

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Yu-Jiun Fan ◽  
Po-Cheng Lo ◽  
Yuan-Yu Hsu ◽  
I-Shiang Tzeng ◽  
Bo-Chun Wei ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Pectus Excavatum ◽  
Slope Angle ◽  
Chest Radiographs ◽  
The Other ◽  
Nuss Procedure ◽  
Patient Groups ◽  
Lateral Chest ◽  
The Impact ◽  
Improvement Index

Abstract Background The Nuss procedure is widely used to correct pectus excavatum. Bar displacement is a common complication associated with this procedure. How the flipping of the bar affects pectus excavatum recurrence has not been reported. In our study, we discuss this and also offer an easier method to determine bar flipping. Methods This retrospective study analyzed pectus excavatum patients who underwent primary Nuss repair from August 2014 to December 2018. The preoperative and postoperative Haller indices were measured on chest radiographs (cxrHI). The slope angle of bar flipping (α) was measured on lateral chest radiographs. The improvement index after surgical repair was calculated by: ([preoperative cxrHI-postoperative cxrHI]/preoperative cxrHI × 100). The impact of α on the improvement index was analyzed using one-way analysis of variance and receiver operating characteristic tests. Results In this study, 359 adult and adolescent patients with an average age of 23.9 ± 7.7 years were included. We formed four subgroups based on the α value: α ≤ 10° (n = 131), α = 11–20° (n = 154), α = 21–30° (n = 51), and α > 30° (n = 23). The mean improvement indices in these groups were 27%, 28%, 26%, and 13%, respectively. Patients with α > 30° were associated with a significantly poorer improvement index than those from the other subgroups (p < 0.001). Conclusions The α value is an alternative measurement method for presenting the radiological outcomes after the Nuss procedure. An α > 30° indicates a possible recurrence of pectus excavatum after the Nuss repair. Surgical revision may be considered in patients with an α > 30°, while monitoring should be considered in the other patient groups.

Variations in Nuss Procedure Operative Techniques and Complications: A Retrospective Review

2021 ◽  
Author(s):  
Centura R. Anbarasu ◽  
Steven C. Mehl ◽  
Raphael C. Sun ◽  
Jorge I. Portuondo ◽  
Andres F. Espinoza ◽  
...  
Keyword(s):  
Retrospective Review ◽  
Pectus Excavatum ◽  
Statistical Significance ◽  
Intercostal Nerve ◽  
Nuss Procedure ◽  
Operative Techniques ◽  
Chi Square ◽  
Patient Demographics ◽  
Haller Index ◽  
Increased Risk

Abstract Introduction The Nuss procedure is the most common and preferred operative correction of pectus excavatum. Surgeon preference and patient factors can result in variations in Nuss procedure technique. We hypothesize that certain techniques are associated with increased risk of complications. Materials and Methods We performed a single-center retrospective review of Nuss operations from 2016 to 2020. Variations in intraoperative techniques included sternal elevator (SE) use, number of bars placed, and usage of bilateral stabilizing sutures. Patient demographics, intraoperative data, and postoperative outcomes were reported as median with interquartile ranges or percentages. Statistical significance (p < 0.05) was determined with Wilcoxon's rank-sum and chi-square tests. Multivariate analysis was performed to control for introduction of intercostal nerve cryoablation and surgeon volume, and reported as odds ratio with 95% confidence interval. Results Two hundred and sixty-five patients were identified. Patients repaired with two bars were older with a larger Haller index (HI). Patient demographics were not significantly different for SE or stabilizing suture use. Placement of two bars was associated with significantly increased risk of readmission. Similarly, SE use was associated with increased risk of pleural effusion and readmission. Finally, the use of bilateral stabilizing sutures resulted in less frequent slipped bars without statistical significance. Conclusion Older patients with a larger HI were more likely to need two bars placed to repair pectus excavatum. Placement of multiple bars and SE use are associated with significantly higher odds of certain complications.

scholarly journals Three-Dimensional Simulation for Breast Augmentation of Female Asymmetric Pectus Excavatum: A Case Report

2019 ◽  
Vol 1 (2) ◽  
Author(s):  
Yoshichika Yasunaga ◽  
Aya Tsuchiya ◽  
Yuta Nakajima ◽  
Shoji Kondoh ◽  
Masahiko Noguchi ◽  
...  
Keyword(s):  
Chest Wall ◽  
Breast Augmentation ◽  
Pectus Excavatum ◽  
Three Dimensional ◽  
Anterior Chest Wall ◽  
Nuss Procedure ◽  
Breast Asymmetry ◽  
Level Of Evidence ◽  
Dimensional Simulation ◽  
The Right

Abstract Breast augmentation for women with asymmetric pectus excavatum (PE) has a characteristic problem in that surgeons need to select implants while considering the left-right difference in breast volume, contour, and position. We herein report a 33-year-old woman with severe asymmetric PE who presented with residual breast asymmetry after chest wall correction using the Nuss procedure. Her right breast appeared hypoplastic and the right anterior chest wall remained depressed. Augmentation of the right breast with a silicone implant was performed, selecting the inserted implant preoperatively with the assistance of three-dimensional (3D) simulation. The breast asymmetry and anterior chest wall depression were improved to a natural appearance. Three-dimensional simulation represents an advantageous way to preoperatively select optimal implants for breast augmentation in asymmetric PE women with breast asymmetry. Level of Evidence: 5

scholarly journals The hemodynamics during the Nuss procedure for repair of pectus excavatum

2020 ◽  
pp. 7-14
Author(s):  
I.I. Myhal ◽  
Keyword(s):  
Blood Pressure ◽  
General Anesthesia ◽  
Epidural Anaesthesia ◽  
Pectus Excavatum ◽  
Nuss Procedure ◽  
Hemodynamic Parameters ◽  
Regional Analgesia ◽  
Haller Index ◽  
Parents And Children ◽  
Key Words Hemodynamics

Introduction. The hemodynamic parameters during the Nuss procedure for repair of pectus excavatum are under the influence of surgical procedures and anesthetic components especially regional blocks. The aim of the study: analysing the hemodynamic parameters during the Nuss procedure for repair of pectus excavatum under the combination of general anesthesia with different regional analgesia techniques. Materials and methods. The observative prospective study inclueded 60 adolescents (boys/girls=47/13) undergone the Nuss procedure for repair of pectus excavatum under the combination of general anesthesia with different types of regional blocks. The patients were randomized into three groups (n=20 in each) according to the regional analgesia technique: standart epidural anaesthesia in the dermatome of maximal deformity (SEA), high epidural anaesthesia in Th2-Th3 level (HEA) and bilateral paravertebral anaesthesia (PVA). The deformity severity by Haller index in all patients was 3.9 [3.6–4.1]. The blood pressure (BP) and heart rate (HR) were analyzed at different stages of anesthesia and surgery. Results. SEA resulted to significant derease in BP up to 30% compared to initial level before anesthesia. In the HEA group the decrease in BP was moderate and in PVA group the BP did not decrease at all. The sternal elevation and applying capnothorax increased BP without increasing HR. The bar rotation provided a little hemodynamic change in spite of being the most traumatic moment of such surgery. Under PVA HR was moderately increased but BP was almost unchanged, and the intraoperative infusion volume was the smallest in PVA group. HEA provided more stable hemodynamics in comparison to SEA. At the end of surgery hemodynamic parameters almost the same as initial before surgery. Conclusions. During the Nuss procedure for pectus excavatum repair the blood pressure decreased significantly under the standart epidural anaesthesia in the dermatome of maximal deformity, moderately – under the high epidural anaesthesia in Th2-Th3 level and was stable under the bilateral paravertebral anaesthesia. HR decreased under epidural blocks but not under PVA. The sternal elevation and applying capnothorax increased BP. The initial hemodynamic parameters before surgery did not correlate with the severity of deformity according to the Haller index. The study was conducted in accordance with the principles of the Helsinki Declaration. The study protocol was approved by the Local Ethics Committee of the institution. Informed consent of parents and children was obtained for the study. The author declares no conflict of interest. Key words: hemodynamics, pectus excavatum, Nuss procedure, epidural anaesthesia, paravertebral anaesthesia.

scholarly journals Minimally Invasive Modified Nuss Procedure for Repair of Pectus Excavatum in Pediatric Patients: Single-Centre Retrospective Observational Study

Children ◽  
2021 ◽  
Vol 8 (11) ◽  
pp. 1071
Author(s):  
Miro Jukić ◽  
Ivan Mustapić ◽  
Tomislav Šušnjar ◽  
Zenon Pogorelić
Keyword(s):  
Minimally Invasive ◽  
Hospital Stay ◽  
Pectus Excavatum ◽  
Pediatric Patients ◽  
Intraoperative Complications ◽  
Late Complications ◽  
Nuss Procedure ◽  
Early Complications ◽  
Female Patients ◽  
Haller Index

Background: The treatment of pectus excavatum can be conservative or surgical. The aim of this study was to determine the factors influencing the outcomes of treatment after a minimally invasive Nuss corrective surgery procedure in pediatric patients. Methods: A total of 30 patient who underwent a minimally invasive Nuss corrective procedure for pectus excavatum from 1 January 2014 to 31 December 2020 were included in thisretrospective study. The collected data included thepatient’s demographic characteristics (age, sex, height, weight, body mass index—BMI, Haller index), treatment outcomes (duration of surgery, length of hospital stay, intraoperative complications, early and late complications, postoperative analgesia), and overall patient and legal guardian satisfaction two years after the procedure. Results: A total of 22 male and 8 female patients were included in the study. The median age was 15 years (interquartile range—IQR 14, 16), and the median BMI was 18.5 kg/m2 (IQR 17.7, 20.4) and 18.2 kg/m2 (IQR 16.9, 18.6) for males and females, respectively. The median CT Haller index was 3.67 (IQR 3.48, 4.09) for male and 3.69 (IQR 3.45, 3.9) for female patients. The median surgery duration was 120 min (IQR 100, 130), and the median hospital stay length was 8.5 days (IQR 8, 9.75). Indications for surgery were psychological (47%), followed by respiratory (30%) and combined respiratory-cardiac (20%) and respiratory-psychological disorders (3%). Early complications were observed in 18 patients (60%), and late complications were observed in 7 patients (23.3%). Intraoperative complications were not recorded. The most common early complications were pneumothorax and subcutaneous emphysema (30%), while late complications included bar displacement (10%) and deformity recurrence (6.6%). Overall,the procedure was successful in 93.1% of patients. Upon arrival home, 22 patients (81.5%) used analgesics for at least one day, up to a maximum of six months. A total of 23 (76.7%) operated patients determined that the surgical procedure had excellent results (grade 5) , 4 (13.3%) patients report a good result (grade 4), 1(3.3%) patient reported a mediocre result, and one patient (3.3%) reported a bad result (grades 3 and 2, respectively). Conclusion: The Nuss procedure is a safe and effective method for treating funnel chest in children and adolescents. It also providesexcellent cosmetic and aesthetic results as well as subjective satisfaction with the outcome of surgical treatment.

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.

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