Pulmonary function and exercise response in patients with pectus excavatum after nuss repair

Borowitz, Drucy; Cerny, Frank J.; Zallen, Garret; Sharp, Jack; Burke, Mark S.; Gross, Kara J.; Glick, Philip L.

doi:10.1053/jpsu.2003.50118

Cited by 74 publications

(44 citation statements)

References 17 publications

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“…Borowitz et al found that in 10 Nuss procedure patients in New York, there was no improvement but also no adverse effect on either static pulmonary function tests (PFT's) or on the ventilator response to exercise (12). This was important because it © Annals of Cardiothoracic Surgery.…”

Section: Resultsmentioning

confidence: 99%

Diminished pulmonary function in pectus excavatum: from denying the problem to finding the mechanism

Kelly¹,

Obermeyer²,

Nuss³

2016

Ann. Cardiothorac. Surg.

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Background: Recently, technical improvement in the ability to measure lung function and the severity of chest deformity have enabled progress in understanding the mechanism of limitations of lung function in pectus excavatum.Methods: After establishing that most patients with pectus excavatum do have symptoms of exercise intolerance, easy fatigability, and shortness of breath with exertion, lung function has been evaluated by a variety of methods in different centers. Spirometry, plethysmography, exercise testing, oculo electronic plethysmography, and imaging methods have been used to assess lung function in pectus excavatum and its response to surgery.Results: Not all patients with pectus excavatum have subnormal static pulmonary function testing; some have above-average values. However, in more than 1500 adult and pediatric surgical patients with anatomically severe pectus excavatum at a single center, the bell curve of FVC, FEV1, and FEF 25-75 is shifted to significantly lower values in pectus excavatum. The curve is shifted to higher values after operation by approximately one standard deviation. Previous work has demonstrated that patients with more anatomically severe pectus excavatum are more likely to have diminished PFT's. A mechanism for this effect is seen by oculo electronic plethysmography, which demonstrates that the depressed portion of the chest does not move on respiration. After Nuss procedure, the chest wall motion used to create suction to draw air into the lungs is indistinguishable from that of persons with a normal chest, and the intrathoracic volume is markedly increased.Conclusions: Pectus excavatum is accompanied in most patients by diminished static pulmonary function.Correction by Nuss procedure results in improvement in chest wall motion; this improvement in the thoracic bellows action is accompanied by improvement in pulmonary function testing.

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Section: Resultsmentioning

confidence: 99%

Diminished pulmonary function in pectus excavatum: from denying the problem to finding the mechanism

Kelly¹,

Obermeyer²,

Nuss³

2016

Ann. Cardiothorac. Surg.

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“…2) The acceptance and popularity of this technique developed quickly because of its less radical surgery and excellent cosmetic and functional results. 13,14) This method was primarily designed for prepubertal child and the optimal age for repair was recommended between 12 and 16 years. 2,15) Some studies showed a high risk for complications with Nuss procedure in adults, including pneumothorax, pleural effusion or hemothorax, cardiac injury, bar infection and pericarditis.…”

Section: Discussionmentioning

confidence: 99%

Pleural Effusion Complicating after Nuss Procedure for Pectus Excavatum

Cheng

Lin

Wang

et al. 2014

Ann Thorac Cardiovasc Surg

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Purpose: The Nuss procedure is a minimally invasive method for the correction of pectus excavatum (PE). Pleural effusion complicating following the Nuss procedure was uncommon but may be critical. We evaluated the risk factors of postoperative pleural effusion after Nuss repair. Methods: We included all patients with PE primarily corrected by Nuss procedure from July 2005 to December 2011. The clinical features, treatment and outcomes of these patients with pleural effusion were analyzed retrospectively. Results: 390 patients (338 men, 52 women) with a mean age of 23.9 years (5-44 years) were included. Postoperative pleural effusion occurred in 10 patients (2.6%). The time of occurrence of pleural effusion was on a mean of 16.6 days (8-32 days) after operation presenting with progressive dyspnea. All of these patients were adults, and 9 patients (90%) were repaired by two pectus bars (p <0.001). Six patients with massive pleural effusion received thoracocentesis (400 ml-1000 ml). All of the effusions were exudative. These patients took short-term indomethacin or steroids without removal of bars and all recovered well after a mean of 40 months (12-72 months) follow-up. Conclusions: Pleural effusion complicating after Nuss procedure was uncommon. It occurred most on adult patients with placement of double bars. Close follow-up in adults after more than one bar insertion is recommended. Administration of temporary medications of indomethacin/steroid and/or thoracocentesis could obtain a satisfying result. Early administration of indomethacin/steroid in adult patients repaired by two bars with mild pleural effusion for preventing pooling of effusion could also be considered.

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“…The acceptance and popularity of this technique developed quickly because of its less radical surgery and excellent cosmetic and functional results [16,17]. This method was primarily designed for prepubertal child and the optimal age for repair was recommended between 12 and 16 years [2,18].…”

Section: Discussionmentioning

confidence: 99%

Efficacy and safety of modified bilateral thoracoscopy-assisted Nuss procedure in adult patients with pectus excavatum

Cheng

Lee

Huang

et al. 2008

European Journal of Cardio-Thoracic Surgery

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The modified bilateral thoracoscopy-assisted Nuss repair for adult patients could eliminate the risk of cardiopulmonary injuries. It could allow direct inspections in mediastinum and facilitate mediastinal dissection, especially in patients with recurrence, history of previous thoracic procedure or double-bar insertion. Other methods for ensuring safety such as substernal dissection or elevation may be unnecessary.

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Pulmonary function and exercise response in patients with pectus excavatum after nuss repair

Cited by 74 publications

References 17 publications

Diminished pulmonary function in pectus excavatum: from denying the problem to finding the mechanism

Diminished pulmonary function in pectus excavatum: from denying the problem to finding the mechanism

Pleural Effusion Complicating after Nuss Procedure for Pectus Excavatum

Efficacy and safety of modified bilateral thoracoscopy-assisted Nuss procedure in adult patients with pectus excavatum

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