Cardiopulmonary Function in Thoracic Wall Deformities: What Do We Really Know?

Jaroszewski, Dawn E.; Velazco, Cristine S.; Pulivarthi, Venkata Siva Krishna Kumar; Arsanjani, Reza; Obermeyer, Robert J.

doi:10.1055/s-0038-1668130

Cited by 36 publications

(16 citation statements)

References 63 publications

(112 reference statements)

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“…There are several case reports that describe standard implant with no incidences in these patients [42][43][44] . Nevertheless, in severe cases, sternal depression may result in cardiac compression (particularly right cardiac chambers) and lead to morphological and functional alterations such as leftward displacement [45][46][47][48] . In our study there were a very small number of patients with congenital chest abnormalities and thus, we were not able to come to any conclusion on this particular factor.…”

Section: Discussionmentioning

confidence: 99%

Subcutaneos Implantable Cardioverter: Defibrillator: Is the Conventional Pre-Implant Screening Enough to Assess Eligibility?

Brito

Martinez²,

Cladera³

et al. 2023

ijirms

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Aims: The subcutaneous implantable cardioverter-defibrillator (S-ICD) requires screening prior to implantation. Surface anatomical landmarks (SAL) guide the screening. The heart silhouette shows variations, therefore, these landmarks may differ. We aimed to determine the concordance between SAL and fluoroscopy guided screening, and analyze discordance predicting factors. Methods: We performed a conventional SAL guided screening (CS) in left and right parasternal electrode position (LPP/RPP) to candidates for S-ICD. Subsequently, we performed a fluoroscopy guided screening (FGS) according to cardiac silhouette. Screenings in which at least the result of one sensing vector did not coincide were considered “discordant”. A comparison was done between discordant vs. concordant cases. A simple binary logistic regression analysis was performed to assess the risk of being discordant individually for each of the variables. Results: The results of CS and FGS were compared in 110 patients (220 comparisons: 110 LPP and 110 RPP). 90 (40.91%) were discordant in at least one sensing vector (46 in LPP and 44 in RPP). In 3 patients (2.73%) the indication of which type of defibrillator was implanted changed according to the FGS. There were no significant differences between the discordant and concordant screening patients. Conclusion: There is a level of discordance between CS and FGS. There were no analyzed factors that were able to predict discordance between these two screening methods. It might be reasonable to perform FGS before implant.

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Section: Discussionmentioning

confidence: 99%

Subcutaneos Implantable Cardioverter: Defibrillator: Is the Conventional Pre-Implant Screening Enough to Assess Eligibility?

Brito

Martinez²,

Cladera³

et al. 2023

ijirms

View full text Add to dashboard Cite

show abstract

“…PE is caused by excessive growth of the costal cartilage, resulting in a concave anterior chest wall [ 3 ]. The deformities frequently present not only as an aesthetic disturbance but also in association with mild limitation of physical activity, obstructive pulmonary mechanics, slight dyspnoea and abnormal cardiac physiology [ 4 ]. For decades, surgical correction of PE was performed primarily for cosmetic and psychological reasons, without proven postsurgical benefits on cardiopulmonary deficits [ 1 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

The questionable benefit of pectus excavatum repair on cardiopulmonary function: a prospective study

Frari

Blank

Sigl

et al. 2021

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES Since the introduction of the minimally invasive technique for repair of pectus excavatum (MIRPE), increasing numbers of patients are presenting for surgery. However, controversy remains regarding cardiopulmonary outcomes of surgical repair. Therefore, the aim of our prospective study was to investigate cardiopulmonary function, at rest and during exercise before surgery, first after MIRPE and then after pectus bar removal. METHODS Forty-seven patients were enrolled in a prospective, open-label, single-arm, single-centre clinical trial (Impact of Surgical Treatments of Thoracic Deformation on Cardiopulmonary Function) [NCT02163265] between July 2013 and November 2019. All patients underwent a modified MIRPE technique for surgical correction of pectus excavatum (PE), called Minor Open Videoendoscopically Assisted Repair of Pectus Excavatum. The patients underwent pre- and postoperative chest X-ray, three-dimensional volume-rendering computer tomography thorax imaging, cardiopulmonary function tests at rest and during stepwise cycle spiroergometry (sitting and supine position) and Doppler echocardiography. Daily physical activity questionnaires were also completed. RESULTS The study was completed by 19 patients (15 males, 4 females), aged 13.9–19.6 years at the time of surgery. The surgical patient follow-up was 5.7 ± 7.9 months after pectus bar removal. No significant differences in cardiopulmonary and exercise parameters were seen after placement of the intrathoracic bar, or after pectus bar removal, compared to presurgery. CONCLUSIONS Our findings indicate that surgical correction of PE does not impair cardiopulmonary function at rest or during exercise. Therefore, no adverse effects on exercise performance should be expected from surgical treatment of PE via the modified MIRPE technique. Clinical trial registration number clinicaltrials.gov [ClinicalTrials.gov number, NCT02163265].

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“…About one-third of the patients with CBT have rib fractures [ 3 , 4 ]. Severe rib fractures are often associated with thoracic collapse, which can significantly reduce the thoracic volume if not corrected in time [ 5 , 6 ]. Therefore, assessment of thoracic volume changes is critical for evaluation of the degree of injury and treatment decisions in patients with CBT.…”

Section: Introductionmentioning

confidence: 99%

Assessment of thoracic volume changes after the collapse of lateral rib fractures based on chest computed tomography data: computer simulation and a multiple variable linear regression analysis

Chen

Liu

Guo³

et al. 2020

J Cardiothorac Surg

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Background Chest blunt trauma (CBT) and the resultant rib fractures often lead to thoracic collapse. The purpose of this study was to explore the effect of displacement of the rib fracture and thoracic collapse on the thoracic volume by using normal chest CT data. Methods In this retrospective study, seven consecutive normal participants were selected from our hospital between June and July 2018. Normal thoracic models were reconstructed, followed by simulation of lateral fractures through the 4th to 9th ribs under three collapse modes with 1–5 cm of collapse. The thoracic collapse models ( n = 630) were reconstructed using 3Dmax 2014. We calculated the thoracic volume and reduction percentage for each thoracic collapse model. Linear regression-based comparisons of thoracic volume reductions were performed. Results In all three collapse modes, the degree of the collapse was linearly correlated with the mean thoracic volume reduction. The reduction percentage in the posterior collapse mode was higher than that in the anterior collapse mode ( P < 0.001). The largest volume reductions in the anterior, posterior, and simultaneous collapse models were in the 6th rib fracture model ( P < 0.001), 8th rib fracture model ( P < 0.001), and 7th rib fracture model ( P < 0.001), respectively. Conclusions The influences of rib fracture displacement and collapse on the thoracic volume in the 6th through 8th ribs are critical in lateral rib fractures. For patients with 6th to 8th rib fractures and posterior rib collapse, surgical intervention to restore thoracic volume may be more essential.

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Cardiopulmonary Function in Thoracic Wall Deformities: What Do We Really Know?

Cited by 36 publications

References 63 publications

Subcutaneos Implantable Cardioverter: Defibrillator: Is the Conventional Pre-Implant Screening Enough to Assess Eligibility?

Subcutaneos Implantable Cardioverter: Defibrillator: Is the Conventional Pre-Implant Screening Enough to Assess Eligibility?

The questionable benefit of pectus excavatum repair on cardiopulmonary function: a prospective study

Assessment of thoracic volume changes after the collapse of lateral rib fractures based on chest computed tomography data: computer simulation and a multiple variable linear regression analysis

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