Prospective Multicenter Study of Surgical Correction of Pectus Excavatum: Design, Perioperative Complications, Pain, and Baseline Pulmonary Function Facilitated by Internet-Based Data Collection

Kelly, Robert E.; Shamberger, Robert C.; Mellins, Robert B.; Mitchell, Karen K.; Lawson, M. Louise; Oldham, Keith T.; Azizkhan, Richard G.; Hebra, André; Nuss, Donald L.; Goretsky, Michael J.; Sharp, Ronald J.; Holcomb, George; Shim, Walton K.T.; Megison, Stephen M.; Moss, Richard L.; Fecteau, Annie; Colombani, Paul M.; Bagley, Traci; Moskowitz, Alan

doi:10.1016/j.jamcollsurg.2007.03.027

Cited by 193 publications

(96 citation statements)

References 26 publications

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“…Magnetic resonance imaging can be used instead of CT scan to reduce radiation exposure but bony detail is better seen by a CT scan. 8,17,25 An index of severity can be calculated by measuring the inner width of the chest (at the lowest level of the pectus defect) and dividing it by the distance between the posterior surface of the sternum (at the lowest part of the defect) and the anterior surface of the spine. 17,28,45 The severity index for healthy people is 2.52.…”

Section: Radiographic Evaluationmentioning

confidence: 99%

See 1 more Smart Citation

Current Management of Pectus Excavatum: A Review and Update of Therapy and Treatment Recommendations

Jaroszewski¹,

Notrica²,

McMahon³

et al. 2010

The Journal of the American Board of Family Medicine

185

152

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Pectus excavatum (PE) is a posterior depression of the sternum and adjacent costal cartilages and is frequently seen by primary care providers. PE accounts for >90% of congenital chest wall deformities. Patients with PE are often dismissed by physicians as having an inconsequential problem; however, it can be more than a cosmetic deformity. Severe cases can cause cardiopulmonary impairment and physiologic limitations. Evidence continues to present that these physiologic impairments may worsen as the patient ages. Data reports improved cardiopulmonary function after repair and marked improvement in psychosocial function. More recent consensus by both the pediatric and thoracic surgical communities validates surgical repair of the significant PE and contradicts arguments that repair is primarily cosmetic. We performed a review of the current literature and treatment recommendations for patients with PE deformities. (J Am Board Fam Med 2010;23:230 -239.)

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Section: Radiographic Evaluationmentioning

confidence: 99%

“…8,45 In general, an index of Ն3.1 is considered severe. 2,3,5,8,13,14,[17][18][19]25,46,47 Electrocardiogram Documentation of any dysrhythmias should be done with a 12-lead electrocardiogram.…”

Section: Radiographic Evaluationmentioning

confidence: 99%

Current Management of Pectus Excavatum: A Review and Update of Therapy and Treatment Recommendations

Jaroszewski¹,

Notrica²,

McMahon³

et al. 2010

The Journal of the American Board of Family Medicine

185

152

View full text Add to dashboard Cite

show abstract

“…Other, less adopted, conservative procedures have been described, based on a suction device (Vacuum Bell) (Schier et al, 2005) or magnetic forces (Harrison et al, 2007), and proposed as attempts to correct PE without any surgical maneuver, but results still need to be proved. Results in all series (Acastello, 2006;Kelly et al, 2007;Lopushinsky & Fecteau, 2008;Nuss, 2008) are usually good in more than 80-90% of cases, depending on the gravity, type of PE and age of correction. The largest experience of 1215 patients is reported by Nuss and colleagues (Kelly et al, 2010), who report a 95.8% surgeon's satisfaction rate, 93% patient's satisfaction rate and a 92% parent's satisfaction rate.…”

Section: Diagnostic Assessment and Classificationmentioning

confidence: 93%

“…In cases of severe malformations there can be physiological repercussions. Many studies have tried to elucidate the implications of PE on the respiratory and cardiac function (Colombani, 2009;Kelly, 2007Kelly, , 2008Williams & Crabbe, 2003). Sternal depression causes a leftward displacement of the heart.…”

Section: Type I: Cartilaginous Anomalies 211 Pectus Excavatum (Pe)mentioning

confidence: 99%

Chest Wall Deformities: An Overview on Classification and Surgical Options

Torre¹,

Rapuzzi²,

Jasonni³

et al. 2012

Topics in Thoracic Surgery

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“…The theory is supported by the work of Castellani et al which showed that forced vital capacity after implant removal reached normal values, and was not significantly different from preoperative FVC (p = 0.117) [47]. Spinal distortion, wound infection, pneumothorax, pleural and pericardial effusion, bar displacement, allergy to the bar, overcorrection in PE patients leading to PC, bleeding from erosion of costal arteries due to movement of the ribs against the bar resulting in hemothorax, aortic laceration, cardiac arrhythmia, and cardiac perforation have all been reported as operative complications of the Nuss procedure [2,37,41,[48][49][50]. Patients greater than 15 years of age are at higher risk for complications due to the higher force necessary to elevate the sternum to the desired level [41].…”

Section: Newer Treatment Modalitiesmentioning

confidence: 94%

Advances in the management of pectus deformities in children

Swergold¹,

Sridharan²,

Loukas³

et al. 2013

OJPed

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Pectus excavatum (PE) and pectus carinatum (PC) are relatively common deformities involving the anterior chest wall, occurring in 1:1000 and 1:1500 live births, respectively. While the etiology remains an enigma, the association of pectus deformities with other skeletal abnormalities suggests that connective tissue disease may play a role in their pathogenesis. Clinical features of these deformities vary with severity, as determined by the Haller index and Backer ratio, but frequently include cardiac and respiratory abnormalities. Importantly, there exist profound psychosocial implications for children afflicted with these deformities, including but not limited to feelings of embarrassment and maladaptive social behaviors. These debilitating characteristics have prompted the development of novel medical and surgical corrective techniques. The correction of pectus deformities reduces the incidence of physiological complications secondary to chest wall malformation, while simultaneously improving body image and psychosocial development in the affected pediatric population. The Ravitch (open) and Nuss (minimally invasive) procedures remain the most frequently employed methods of pectus deformity repair, with no difference in overall complication rates, though individual complication rates vary with treatment. The Nuss procedure is associated with a higher rate of recurrence due to bar migration, hemothorax, and pneumothorax. Postoperative pain management is markedly more difficult in patients who have undergone Nuss repair. Patients undergoing the Ravitch procedure require less postoperative analgesia, but have longer operation times and a larger surgical scar. The cosmetic results of the Nuss procedure and its minimally invasive nature make it preferable to the Ravitch repair. Newer treatment modalities, including the vacuum bell, magnetic mini-mover procedure (3MP), and dynamic compression bracing (DCB) appear promising, and may ultimately provide effective methods of noninvasive repair. However, these modalities suffer from a lack of extensive published evidence, and the limited number of studies currently published fail to adequately define their long-term effectiveness.

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Prospective Multicenter Study of Surgical Correction of Pectus Excavatum: Design, Perioperative Complications, Pain, and Baseline Pulmonary Function Facilitated by Internet-Based Data Collection

Cited by 193 publications

References 26 publications

Current Management of Pectus Excavatum: A Review and Update of Therapy and Treatment Recommendations

Current Management of Pectus Excavatum: A Review and Update of Therapy and Treatment Recommendations

Chest Wall Deformities: An Overview on Classification and Surgical Options

Advances in the management of pectus deformities in children

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