A novel technique to measure severity of pediatric pectus excavatum using white light scanning.

Background/purpose

Computed tomography (CT) derived Haller Index (HI) remains the standard for quantifying severity in patient with pectus excavatum (PE). Optical scanning described in literature reports optimistic results and new indices that correlate with HI. This study assessed the feasibility of a handheld White Light Scanner (WLS) to obtain 3D measurements and indices of PE deformity.

漏斗胸Nuss矫形术对胸廓的影响及相关因素分析

目的通过CT影像测量了解漏斗胸Nuss矫形术前后胸廓径线的改变情况,探讨并分析Nuss矫形术对胸廓的影响及相关因素。方法对2014年1月至2018年12月郑州大学第一附属医院收治的50例行漏斗胸Nuss矫形术患儿的临床资料进行回顾性分析。50例患儿中男43例,女7例。所有患儿中存在脊柱侧弯6例,胸廓不对称12例,胸骨旋转11例。通过CT影像测量其放置矫形器前及取出矫形器后胸廓各椎体平面最大横内径及该平面胸脊间的距离,通过配对样本t检验比较矫形前后各径线的改变情况,以及通过独立样本t检验分析在不同年龄、性别、矫形时间、漏斗胸对称与否、是否合并脊柱侧弯等情况间的差异性。结果50例患儿均顺利完成矫形器置入术及矫形器拔除术,无明显术中及术后并发症,Nuss矫形后较矫形前相比,胸廓前后径在第8~12胸椎水平均较前增加,第3~5胸椎平面较前减小,胸廓横径在第8~10胸椎平面较前减小;年龄≤10岁、矫形时长≥2年及女性患儿胸廓前后径改变量在多个胸椎平面分别较年龄>10岁、矫形时长<2年及男性患儿大,P<0.05,差异具有统计学意义。结论漏斗胸Nuss矫形后前胸壁凹陷较前明显改善,并且在不同年龄和不同矫形时长间存在差异性,年龄较小及适当增加矫形时间可获得较好的矫形效果,而胸廓横径生长在一定程度上受限。     

Surgical repair of pectus excavatum relieves right heart chamber compression and improves cardiac output in adult patients—an intraoperative transesophageal echocardiographic study

Background

Cardiac compression in pectus excavatum (PE) deformity and effect of PE surgery on cardiac function in adults have been debated. We examined the effect of PE correction on right heart size and cardiac output.

Methods

A retrospective evaluation was performed of 168 adult patients who underwent a modified Nuss PE repair with intraoperative transesophageal echocardiography from 2011 to 2014. Seventeen patients with prior PE repair undergoing bar removal acted as controls.

Results

Mean age was 33.0 years (range, 18 to 71 years). There was an increase in right atrium (15.1%), tricuspid annulus (10.9%), and right ventricular outflow tract (6.1%) size after surgery (all P < .0001). Right ventricular cardiac output measured in a subset of 42 patients improved by 38%. No change in chamber size or cardiac output occurred before and after bar removal surgery in the control group.

Conclusions

Surgical correction of PE deformity caused a significant improvement in right heart chamber size and cardiac output.     

Malformations of the anterior chest wall

INTRODUCTION: Pectus excavatum or funnel chest is the most common anterior chest wall deformity seen in children and adults. The sternal depression appears to be caused by overgrowth of the costal cartilages, also the cause of the less common deformities: pectus carinatum (pigeon breast) and pectus arcuatum. BACKGROUND: Usually the overgrowth involves the third to seventh costal cartilages but it can be more or less extensive. The cardiopulmonary functional consequences are insignificant in the protrusional deformities and inconsistent in pectus excavatum and the indications for surgery are mainly cosmetic. VIEWPOINT AND CONCLUSIONS: The procedural modalities are guided by morphological study of the CT scan. We describe a surgical technique that comprise subperichondrial excision of all deformed costal cartilages followed by transverse sternotomy to correct the sternal deformity, anteriorly in the case of pectus excavatum and posteriorly for pectus carinatum and arcuatum. As the perichondrial sheaths are totally preserved they are sutured in continuous layers to give a shortening effect. In the case of pectus excavatum the sternum is then secured anteriorly for about 6 months by a retrosternal metallic strut in an overcorrected position. The partially resected seventh cartilages are then sutured to the xiphoid. Other surgical techniques are described, including modified Ravitch's procedure, modelling osteochondroplasty, prosthetic reconstruction and Nuss's procedure. Results of the more important series are reported and discussed.     

Nuss手术治疗漏斗胸31例临床观察

目的:探讨Nuss手术矫正漏斗胸的优越性。方法:实施漏斗胸矫形术共31例。其中10例使用胸腔镜,21例未使用胸腔镜;2例使用固定片,29例使用钢丝固定。结果:手术过程顺利,手术时间为60~90 m in,术中出血量5~15 m l,术后平均9~12 d出院,无并发症发生。出院后随诊2年,30例患者漏斗胸矫形满意,1例术后复发。矫形成功的患者中,有2例钢丝折断。结论:Nuss手术具有切口小而隐蔽、手术时间短、手术创伤小、出血少、活动早、无手术瘢痕、矫形效果好等优点,使用胸腔镜可确保术程清晰可示,手术方法安全可行,值得推广。