Cardiac perforation by a pectus bar after surgical correction of pectus excavatum: case report and review of the literature

Gips, Hadas; Zaitsev, Konstantin; Hiss, Jehuda

doi:10.1007/s00383-007-2097-1

Cited by 65 publications

(35 citation statements)

References 15 publications

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“…Today, the minimally-invasive repair of pectus excavatum (MIRPE) is well established and is the 'goldstandard' for surgical repair of PE in adolescents (3)(4)(5)(6)(7)(8). However, MIRPE is operator-dependent and has a number of potential complications, which have been widely reported in the literature (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14).…”

Section: Introductionmentioning

confidence: 99%

Vacuum bell therapy

Haecker

Sesia

2016

Ann. Cardiothorac. Surg.

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Background: For specific therapy to correct pectus excavatum (PE), conservative treatment with the vacuum bell (VB) was introduced more than 10 years ago in addition to surgical repair. Preliminary results using the VB were encouraging. We report on our 13-year experience with the VB treatment including the intraoperative use during the Nuss procedure and present some technical innovations.Methods: A VB with a patient-activated hand pump is used to create a vacuum at the anterior chest wall.Three different sizes of vacuum bells, as well as a model fitted for young women, exist. The appropriate size is selected according to the individual patient's age and ventral surface. The device should be used at home for a minimum of 30 minutes (twice a day), and may be used up to a maximum of several hours daily. The intensity of the applied negative pressure can be evaluated with an integrated pressure gauge during followup visits. A prototype of an electronic model enables us to measure the correlation between the applied negative pressure and the elevation of the anterior chest wall.Results: Since 2003, approx. 450 patients between 2 to 61 years of age started the VB therapy. Age and gender specific differences, depth of PE, symmetry or asymmetry, and concomitant malformations such as scoliosis and/or kyphosis influence the clinical course and success of VB therapy. According to our experience, we see three different groups of patients. Immediate elevation of the sternum was confirmed thoracoscopically during the Nuss procedure in every patient. Conclusions:The VB therapy has been established as an alternative therapeutic option in selected patients suffering from PE. The initial results up to now are encouraging, but long-term results comprising more than 15 years are so far lacking, and further evaluation and follow-up studies are necessary.

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Section: Introductionmentioning

confidence: 99%

Vacuum bell therapy

Haecker

Sesia

2016

Ann. Cardiothorac. Surg.

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“…However, with the widespread use of the MIRPE procedure, the character and number of complications have increased [4,[6][7][8][10][11][12]. Above all, recent studies report on an increasing number of near fatal complications [12][13][14][15][16][17][18]. Additionally, in many cases of PE, the degree of pectus deformity does not immediately warrant surgery.…”

Section: Introductionmentioning

confidence: 99%

The vacuum bell for conservative treatment of pectus excavatum: the Basle experience

Haecker

2011

Pediatr Surg Int

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Objective Surgical repair of pectus excavatum (PE) in childhood is a well-established procedure. Previously used operative techniques to correct PE were largely based on the Ravitch technique. Since about 10 years, the minimally invasive repair (MIRPE) by Nuss is well established. Conservative treatment with the vacuum bell to elevate the funnel in patients with PE represents a potential alternative to surgery in selected patients. Methods A suction cup is used to create a vacuum at the anterior chest wall. Three different sizes of vacuum bell exist which are selected according to the individual patients age. When creating the vacuum, the lift of the sternum is obvious and remains for a different time period. The device should be used for a minimum of 30 min (twice/day), and may be used up to a maximum of several hours daily. Results One hundred and thirty-three patients (110 males, 23 females) aged from 3 to 61 years (median 16.21 years) used the vacuum bell for 1 to a maximum of 36 months. Computed tomographic scans showed that the device lifted the sternum and ribs immediately. In addition, this was confirmed thoracoscopically during the MIRPE procedure. One hundred and five patients showed a permanent lift of the sternum for more than 1 cm after 3 months of daily application. Thirteen patients stopped the application and underwent MIRPE. Relevant side effects were not noted. Conclusion The vacuum bell has proved to be an alternative therapeutic option in selected patients suffering from PE. The initial results proved to be dramatic, but long-term results are so far lacking, and further evaluation and follow-up studies are necessary.

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“…In the literature there are only a few reports of fatal complications resulting from heart or vascular injuries [15][16][17][18]. In our material there were no deaths in the early postoperative period.…”

Section: Discussionmentioning

confidence: 46%

Thoracic surgery Early and late results of the Nuss operation for pectus excavatum – a single institution experience

Pawlak¹,

Zieliński²,

Gabryel³

et al. 2013

kitp

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StreszczenieWstęp: Obecnie małoinwazyjna metoda Nussa jest powszechnie uznanym sposobem chirurgicznego leczenia klatki piersiowej lejkowatej. Celem pracy była ocena wyników leczenia operacyjnego klatki piersiowej lejkowatej metodą Nussa, ze szczególnym uwzględ-nieniem stosowanej techniki chirurgicznej. Materiał i metody: Od 2002 r. do 2010 r. u 622 pacjentów (średnia wieku 18,2 roku) wykonano zabieg operacyjny metodą Nussa z powodu klatki piersiowej lejkowatej. Jedną płytkę korekcyjną wszczepiono u 317 pacjentów, dwie płytki u 296, a trzy u pozostałych 9 pacjentów. Implanty usuwano po 2,5-3 latach. Wyniki: Dobre i bardzo dobre wyniki korekcji metodą Nussa uzyskano u 593 (95,3%) pacjentów. Nie obserwowano zgonów we wczesnym okresie pooperacyjnym. Przemijające i niegroź-ne dla życia powikłania wystąpiły w 213 (34,24%) przypadkach -najczęściej była to odma i płyn w opłucnej (22,5%). Asymetryczne i złożone deformacje klatki piersiowej lejkowatej, reoperacja po uprzednio wykonanym zabiegu korekcyjnym, czas operacji powyżej 60 min, wiek powyżej 18 lat, wszczepiona więcej niż jedna płytka korekcyjna oraz płeć męska miały znaczący wpływ na występowanie powikłań w okresie pooperacyjnym. Wnioski: 1. Małoinwazyjna metoda Nussa zapewnia bardzo dobre i dłu-gotrwałe wyniki w leczeniu klatki piersiowej lejkowatej. 2. Kontrola wideotorakoskopowa podczas implantacji płytek korekcyjnych może zapobiec ewentualnemu uszkodzeniu narządów śródpiersia. 3. U pacjentów poniżej 18. roku życia liczba powikłań jest znacznie niższa (p = 0,0025). Słowa kluczowe: klatka lejkowata, operacja Nussa, powikłania pooperacyjne. THORACIC SURGERY AbstractObjective: The purpose of this study was to evaluate the results of operative treatment of pectus excavatum using the Nuss method, with particular emphasis on the surgical technique used. Material and methods: Between 2002 and 2010, 622 patients (mean age 18.2) underwent surgical correction for pectus excavatum. One Nuss bar was implanted in 317 patients, two plates in 296, and 3 in the remaining nine patients. Metal bars were removed after 2.5-3 years. Results: Good and very good corrective effect of the Nuss procedure was achieved in 593 (95.3%) patients. There was no mortality in the early postoperative period. Transient and minor complications occurred in 213 (34.24%) patients -the most frequent were pneumothorax and pleural effusion (22,5%). An asymmetric funnel chest deformity, a complex deformity, reoperation after previously performed corrective surgery, operative time exceeding 60 min, age above 18 years, more than one implanted corrective plate and gender had significant influences on the occurrence of complications in the postoperative period. Conclusions: 1. The Nuss minimal invasive procedure is very effective and provides very good long-term results in the treatment of pectus excavatum. 2. The use of video-thoracoscopic control during insertion of implanted bars may prevent potential damage to the mediastinal organs. 3. In patients below 18 years old the number of postoperative complicati...

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Cardiac perforation by a pectus bar after surgical correction of pectus excavatum: case report and review of the literature

Cited by 65 publications

References 15 publications

Vacuum bell therapy

Vacuum bell therapy

The vacuum bell for conservative treatment of pectus excavatum: the Basle experience

Thoracic surgery Early and late results of the Nuss operation for pectus excavatum – a single institution experience

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