Preoperative multimodality imaging of pectus excavatum: State of the art review and call for standardization

Rodríguez-Granillo, Gastón A.; Martı́nez-Ferro, Marcelo; Capuñay, Carlos; Bellía-Munzón, Gastón; Deviggiano, Alejandro; Raggio, Ignacio; Fernandez-Rostello, Eduardo; Hoyo, Elias Hurtado; Bastarrika, Gorka; Carrascosa, Patrícia

doi:10.1016/j.ejrad.2019.06.014

Cited by 16 publications

(9 citation statements)

References 30 publications

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“… 29 , 30 , 31 , 32 In contrast, other reports found no association between cross‐sectional indices and cardiac function. 13 , 33 In our study, an association between the preoperative cross‐sectional imaging anatomic parameters and the improvement in VO 2 max was not detected, probably as a result of the wide heterogeneity of PE malformations (including differences in the depth of the depression, location of the site of maximum depression, and severity of heart displacement) 34 which may contribute to the inability of standard imaging indices to consistently capture the severity of the adverse physiological impact of PE. Based on our data, we suggest that the approach to assessment of PE severity should not be based on a single diagnostic test or parameter, which clearly carries implications given that specific anatomical parameters, such as HI, are used as criteria for surgical intervention insurance coverage.…”

Section: Discussionmentioning

confidence: 53%

Cardiopulmonary Outcomes After the Nuss Procedure in Pectus Excavatum

Jaroszewski

Farina

Gotway

et al. 2022

JAHA

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Background Pectus excavatum is the most common chest wall deformity. There is still controversy about cardiopulmonary limitations of this disease and benefits of surgical repair. This study evaluates the impact of pectus excavatum on the cardiopulmonary function of adult patients before and after a modified minimally invasive repair. Methods and Results In this retrospective cohort study, an electronic database was used to identify consecutive adult (aged ≥18 years) patients who underwent cardiopulmonary exercise testing before and after primary pectus excavatum repair at Mayo Clinic Arizona from 2011 to 2020. In total, 392 patients underwent preoperative cardiopulmonary exercise testing; abnormal oxygen consumption results were present in 68% of patients. Among them, 130 patients (68% men, mean age, 32.4±10.0 years) had post‐repair evaluations. Post‐repair tests were performed immediately before bar removal with a mean time between repair and post‐repair testing of 3.4±0.7 years (range, 2.5–7.0). A significant improvement in cardiopulmonary outcomes ( P <0.001 for all the comparisons) was seen in the post‐repair evaluations, including an increase in maximum, and predicted rate of oxygen consumption, oxygen pulse, oxygen consumption at anaerobic threshold, and maximal ventilation. In a subanalysis of 39 patients who also underwent intraoperative transesophageal echocardiography at repair and at bar removal, a significant increase in right ventricle stroke volume was found ( P <0.001). Conclusions Consistent improvements in cardiopulmonary function were seen for pectus excavatum adult patients undergoing surgery. These results strongly support the existence of adverse cardiopulmonary consequences from this disease as well as the benefits of surgical repair.

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Section: Discussionmentioning

confidence: 53%

Cardiopulmonary Outcomes After the Nuss Procedure in Pectus Excavatum

Jaroszewski

Farina

Gotway

et al. 2022

JAHA

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“…Stress echocardiography may reveal important circulatory changes which are not present at rest. 11 Postural echocardiography may be of value as it has been described that compromise of the right ventricular outflow tract in pectus excavatum is exacerbated in a sitting upright, 9 or sitting and forward bending position, 12 which was likely relevant in our patient as well. Cardiac MRI may be performed during end expiration, as the degree of cardiac compression worsens with expiration.…”

Section: Discussionmentioning

confidence: 73%

Case report: ventricular fibrillation and cardiac arrest provoked by forward bending in adolescent with severe pectus excavatum

Moossdorff

Maesen

Uijl

et al. 2021

European Heart Journal - Case Reports

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Background Life-threatening arrhythmias have been reported in patients with severe pectus excavatum in absence of other cardiac abnormalities. Literature is scarce regarding diagnosis, cause and management of this problem, particularly regarding the question as to whether the placement of an implantable cardioverter-defibrillator (ICD) is necessary. Case summary A 19-year-old male patient with severe pectus excavatum was scheduled for elective surgical correction. During forward bending for epidural catheter placement, syncope and ventricular fibrillation (VF) occurred resulting in cardiac arrest. After successful cardiopulmonary resuscitation, extensive analysis was performed and showed no cause for VF other than cardiac compression (particularly of the left atrium, right atrium, and ventricle to a lesser degree) due to severe pectus excavatum. Postponed correction by modified Ravitch was performed without ICD placement, with an uneventful post-operative recovery. Eighteen months after surgery, the patient remains well. Upon specific request, he did remember dizzy spells when tying shoelaces. He always considered this unremarkable. Discussion In severe pectus excavatum with cardiac compression, forward bending can decrease central venous return and cardiac output, causing hypotension, arrhythmia, and cardiac arrest. In absence of structural or electric abnormalities, cardiac compression by severe pectus excavatum was considered a reversible cause of VF and ICD placement unnecessary. Patients with cardiac compression due to severe pectus excavatum may report pre-existing postural symptoms upon specific request. When these postural symptoms are present, extreme and prolonged forward bending postures should be avoided.

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“…There have been many studies regarding utilities of automated densitometric analysis by quantitative CT in adults [ 9 - 12 ]. However, only a few studies have been published including the use of an automated quantitative densitometric CT analysis in the paediatric age group [ 17 - 19 ]. Our study is the first article to calculate the lung parenchyma density by automated quantitative CT in children with PE.…”

Section: Discussionmentioning

confidence: 99%

“…Chest CT allows determination of several thoracic indexes to assess the severity of the chest wall deformity and to guide surgical strategies [ 19 ]. Although the degree of chest wall deformity is estimated objectively by the Haller index and correction index, the Haller index is commonly used to establish surgical candidacy [ 19 ]. Normal mean values of the Haller index are described as less than 2.5 [ 13 ].…”

Section: Discussionmentioning

confidence: 99%

Lung density analysis using quantitative computed tomography in children with pectus excavatum

et al. 2021

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IntroductionTo evaluate the mean lung density in children with pectus excavatum (PE) and to assess the correlation between the cardiac rotation angle, Haller index, pulmonary function test, and lung density.Material and methodsThis retrospective study included 33 children with PE and 31 healthy controls. The densities of lung parenchyma were evaluated by quantitative computed tomography (CT). Three lung levels were determined: T4 vertebra level, T10 vertebra level, and the level of the measurement of the cardiac rotation angle. The cardiac rotation angle and the Haller index were calculated. All measurements were done by 2 radiologists, independently. Student’s t-test or the Mann-Whitney U test, intraclass correlation coefficients, Pearson or Spearman’s rank correlation coefficient, and Kruskal-Wallis test were used for statistical analysis. A p-value less than 0.05 was considered as statistically significant.ResultsAll the lung levels in the PE group had lower mean densities than healthy children, with statistical significance in the right lung at the T10 vertebra level (−818.60 ± 33.49 HU, −798.45 ± 40.24 HU; p = 0.028). There was a correlation between the cardiac rotation angle and the Haller index (ρ = 0.593; p < 0.001). There were no correlations between mean lung density and cardiac rotation angle, Haller index, and pulmonary function tests.ConclusionsThe lower mean lung densities were found in PE, especially in the right lower lobe. The parenchymal aeration should be considered independently from the severity of PE.

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Preoperative multimodality imaging of pectus excavatum: State of the art review and call for standardization

Cited by 16 publications

References 30 publications

Cardiopulmonary Outcomes After the Nuss Procedure in Pectus Excavatum

Cardiopulmonary Outcomes After the Nuss Procedure in Pectus Excavatum

Case report: ventricular fibrillation and cardiac arrest provoked by forward bending in adolescent with severe pectus excavatum

Lung density analysis using quantitative computed tomography in children with pectus excavatum

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