Nonoperative management of pectus excavatum with vacuum bell therapy: A single center study

Obermeyer, Robert J.; Cohen, Nina; Kelly, Robert E.; Kuhn, M. Ann; Frantz, Frazier W.; McGuire, Margaret; Paulson, James F.

doi:10.1016/j.jpedsurg.2018.02.088

Cited by 46 publications

(47 citation statements)

References 12 publications

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“…39 Latest reports confirmed the efficacy of VB therapy in carefully selected patients. [40][41][42][43][44][45] In our largest series including more than 500 patients, 80% of PE patients applied for conservative treatment using the VB, whereas 20% underwent surgical repair. 43 This is in concordance with other larger PE patients series.…”

Section: Treatment Of Pectus Excavatummentioning

confidence: 90%

“…Obermeyer et al reported on an excellent outcome for patients 11 years, chest wall depth 1.5cm, chest wall flexibility, and VB use over 12 consecutive months. 45 Pilot studies could confirm the relevance of chest wall flexibility. Dependent on patient's age, the applied differential negative pressure required to the lift the sternum is lower or higher, as well as the duration with the VB is shorter or longer.…”

Section: Treatment Of Pectus Excavatummentioning

confidence: 99%

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Nonsurgical Treatment of Chest Wall Deformities: Contradiction or Complement?

Häcker

2018

Eur J Pediatr Surg

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For decades, open surgical repair was the only available method to treat congenital and acquired chest wall deformities (CWDs). In 1998, D. Nuss described a minimally invasive procedure for surgical repair of pectus excavatum (PE), and a few years later H. Abramson reported on his experience with the "reversed Nuss technique" for surgical repair of pectus carinatum (PC). Both procedures are performed with increasing frequency worldwide.However, nonsurgical measures such as vacuum bell (VB) therapy for conservative treatment of PE and more differentiated bracing systems for conservative treatment of PC were established 15 to 20 years ago. Nowadays, information on new therapeutic modalities circulates not only among surgeons and pediatricians, but also rapidly among patients. In particular, patients who refused operative treatment by previously available procedures now appear at the outpatient clinic and request to be considered for the new methods.Analyzing the increasing number of studies reporting on conservative treatment of CWDs as well as our own group of patients who visited a busy outpatient clinic in a small country within the last 15 to 20 years, we have to realize that the majority of patients asked for nonsurgical treatment of their CWD. Based on these experiences and results, we have to realize that nonsurgical treatment of CWD is no contradiction but a helpful complement to treat congenital and acquired CWDs and may be applied for the majority of patients suffering from a CWD.

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Section: Treatment Of Pectus Excavatummentioning

confidence: 90%

Section: Treatment Of Pectus Excavatummentioning

confidence: 99%

Nonsurgical Treatment of Chest Wall Deformities: Contradiction or Complement?

Häcker

2018

Eur J Pediatr Surg

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“…A major shortcoming of the VB therapy is that it requires remarkable dedication by the patient and family to keep constant use of the device over at least 1 year or even longer [3] during which many are not able to maintain this compliance. Obermeyer, et al [8] reported nearly one third of their patients were either lost to follow-up or poorly compliant. Our patients' compliance seemed higher as we required them to visit us every 3 months to half a year since VB onset.…”

Section: Discussionmentioning

confidence: 99%

“…An excellent correction with VB therapy has been reported from 13.5 to 37.5% [1,4,8,9] though different definitions of excellence were used. Some use absolute depression depth, which does not account for the body size of patients and requires special tools for measurement, to quantify the correctness, while others use Haller Index, Correction Index or the modified percentage depth [10], all of which require a chest CT scan or special calipers to measure dimensions on body surface.…”

Section: Effectiveness and Side Effectsmentioning

confidence: 99%

A novel three-dimensional printed vacuum bell for pectus excavatum treatment: a preliminary study

Deng

Huang

Luo

et al. 2020

J Cardiothorac Surg

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Objective Conservative treatment with a vacuum bell (VB) for pectus excavatum (PE) has now been gradually popularized as an alternative to surgery. We describe our initial experience with a novel three dimensional (3D) printed VB device. Methods Prospectively collected data of all patients who started using a 3D printed VB in 2018 at our institution were analyzed. Linear and logistic regressions were used to identify factors associated with effectiveness of device usage. Results In total, forty-two patients with a median age of 3.6 years were treated with the device. The median follow-up duration was 11.1 months and the mean initial Depth Ratio (DR) was 0.129. There were no permanent sequelae from side effects. Thirty patients with at least one follow-up body scan data showed varying improvement (z = − 4.569, p = 0.0000). Linear regression suggested that longer usage improved outcomes (R2 = 0.235, p = 0.014). By logistic regression there was a trend of younger ages and less initial DR for better improvement though neither was statistically significant (p = 0.086, 0.078, respectively). Conclusion Our initial experience has shown the 3D printed VB may be as effective as other conventional VBs and could be used as an alternative to surgical treatment for selected patients with PE. More experience and studies with this type of VB are needed to demonstrate its superiority with regard to the 3D printing design and optimal timing and indication for use.

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“…We also review in tabular form the salient features of this deformity, the current literature dealing with 2D and 3DTTE findings in this deformity and, for comparison purposes, RV, RA, and TVA 2DTTE/3DTTE findings in normal/healthy subjects. The latter include not only available guidelines but also studies published in the literature after the guidelines were formulated (Tables , Figure ) …”

Section: Anterior Chest Wall Congenital Deformitiesmentioning

confidence: 99%

Incremental value of three‐dimensional transthoracic echocardiography over the two‐dimensional modality in the assessment of right heart compression and dysfunction produced by pectus excavatum

et al. 2018

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The usefulness of two-dimensional transthoracic echocardiography (2DTTE) in the assessment of right heart compression and dysfunction produced by pectus excavatum chest wall deformity has been well described in the literature by several investigators. However, there is a paucity of reports describing incremental value of live/ real time three-dimensional transthoracic echocardiography (3DTTE) over the twodimensional technique in the evaluation of right heart function in these patients. We present a severe case of pectus excavatum chest wall deformity in a young male, in whom 3DTTE provided incremental value over standard 2DTTE in assessing compression of the right heart before surgery and marked improvement in right heart function parameters following surgical repair. In addition, an updated summary of salient features of this deformity, including 2D and 3DTTE findings as well as right heart echocardiographic parameters by both 2D and 3DTTE in normal/healthy subjects summarized from the literature have been provided in a tabular form for comparison. K E Y W O R D Spectus excavatum, right atrium, right heart, right ventricle, right ventricular volume, speckle tracking echocardiography., three-dimensional echocardiography, three-dimensional transthoracic echocardiography, tricuspid valve annulus, two-dimensional echocardiography S U PP O RTI N G I N FO R M ATI O NAdditional supporting information may be found online in the Supporting Information section at the end of the article.Movie S1. Two-dimensional transthoracic echocardiography. How to cite this article: Salama AY, Arisha MJ, Nanda NC, Klas B, Ibeche B, Wei B. Incremental value of threedimensional transthoracic echocardiography over the two-dimensional modality in the assessment of right heart compression and dysfunction produced by pectus excavatum. Echocardiography. 2019;36:150-163. https://doi.

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Nonoperative management of pectus excavatum with vacuum bell therapy: A single center study

Cited by 46 publications

References 12 publications

Nonsurgical Treatment of Chest Wall Deformities: Contradiction or Complement?

Nonsurgical Treatment of Chest Wall Deformities: Contradiction or Complement?

A novel three-dimensional printed vacuum bell for pectus excavatum treatment: a preliminary study

Incremental value of three‐dimensional transthoracic echocardiography over the two‐dimensional modality in the assessment of right heart compression and dysfunction produced by pectus excavatum

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