Transesophageal echocardiography during pectus excavatum correction in children: What happens to the heart?

Laín, Ana; Giralt, Gemma; Giné, C; Martínez, Laura García; Villaverde, Ivan; López, Manuel

doi:10.1016/j.jpedsurg.2020.06.009

Cited by 7 publications

(10 citation statements)

References 30 publications

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“…Similar findings were reported by Jaroszewski et al , with increases in RV outflow tract velocity time integral and RV stroke volume 16. In children, Lain et al showed similar results with RV end diastolic diameter increasing by 5.77 mmm, right atrium diameter by 6.63 mm and tricuspid annulus by 6.02 mm (all p<0.0001) 39…”

Section: Resultssupporting

confidence: 84%

“…Four studies have used intraoperative TOE to demonstrate relief of cardiac compression during repair with similar results 16 39 41 44. In adults, Krueger et al noted significant improvement in postrepair cardiac outputs that increased to 66.2% vs 58.4% and the end-diastolic RV volume that increased to a mean of 40.8 mL vs 21.7 mL preoperatively (p<0.001) 41.…”

Section: Resultsmentioning

confidence: 96%

“…Of the included studies, 12 used echocardiography as an outcome measure to assess for cardiopulmonary improvement following surgery 13 16 17 20–22 34 38–42. Eight of these used TTE presurgery and at postsurgery while four studies used intraoperative transoesophageal echocardiography (TOE).…”

Section: Resultsmentioning

confidence: 99%

“…Distortion of normal cardiac geometry means that often optimal images may only be obtained through a subcostal window and complete evaluation of the heart is limited. In Laín et al , 20 patients showed evidence of compression during TOE, only 6 of which could be seen on preoperative TTE, which highlights the likelihood of underestimating cardiac compression which may in part reflect the divergent results between imaging techniques 39. In contrast, TOE has shown more consistent improvement in cardiac indices.…”

Section: Discussionmentioning

confidence: 99%

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Systematic review of physiological and psychological outcomes of surgery for pectus excavatum supporting commissioning of service in the UK

Walsh,

Redmond

2023

BMJ Open Resp Res

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BackgroundPectus excavatum (PEx) is the most common congenital chest wall abnormality affecting 1 in 400 births in the UK. PEx is associated with significant physiological and psychological impairment. While readily surgically correctable, the benefits that surgery can bring have been debated and proven difficult to objectively measure. In the UK, this has led to the decommissioning of PEx surgery. The aim of this review is to conduct a systematic search of the literature on PEx surgery to assess physiological and psychological outcomes.MethodsA systematic review of the MEDLINE (PubMed), Embase and Cochrane databases was performed. Articles were sought which included patients undergoing surgery for PEx and reported on changes in cardiopulmonary measures, symptoms, quality of life and psychological assessments before and after surgical repair. Last search was performed in July 2022 and relevant findings were synthesised by narrative review.ResultsFifty-one articles were included in qualitative synthesis, with 34 studies relating to physiological outcomes and 17 studies relating to psychological and quality of life measures. Twenty-one studies investigated pulmonary function at rest. There was no change in forced vital capacity or forced expiratory volume in 1 second following open repair and transient reductions followed closed repair. In the 11 studies investigating echocardiography, transthoracic rarely demonstrated cardiac compression; however, transoesophageal demonstrated intraoperative relief in cardiac compression in severe cases. Sixteen studies investigated exercise testing (cardiopulmonary exercise testing, CPET), 12 of which demonstrated significant improvement following surgery, both in maximal oxygen consumption and oxygen pulse. Seventeen studies investigated quality of life, all but one of which showed improvement following repair of PEx. All papers that reported on patient satisfaction following surgery found high rates, between 80% and 97%.DiscussionWhile the majority of studies to date have been small and data heterogeneous, the literature shows that for many patients with PEx, there exists a cardiopulmonary limitation that while difficult to objectify, is likely to improve with surgical repair. Resting parameters offer little yield in aiding this except in the most severe cases. CPET therefore offers a better option for dynamic assessment of this limitation and improvements following repair. Surgery significantly improves psychological well-being and quality of life for patients with PEx.

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Section: Resultssupporting

confidence: 84%

Section: Resultsmentioning

confidence: 96%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Systematic review of physiological and psychological outcomes of surgery for pectus excavatum supporting commissioning of service in the UK

Walsh,

Redmond

2023

BMJ Open Resp Res

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“…Reduced Complications: The use of double bars of Pectus Up may be associated with a lower rate of complications, also compared to the use of two Nuss bars. enhanced stability provided by the second device instead of one, although further research is needed to confirm this potential benefit (6)(7)(8).…”

Section: Discussionmentioning

confidence: 99%

Case Report: Double Pectus Up in severe pectus excavatum, the new frontier of modified taulinoplasty

Frediani,

Corbi,

Pardi

et al. 2024

Front. Pediatr.

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IntroductionPectus excavatum, also known as “sunken chest” or “funnel chest,” is a congenital condition where the sternum caves inward, creating a noticeable depression in the chest. This deformity can range from mild to severe cases, and can affect appearance and lung and heart function. Treatment options vary depending on the severity of the condition and associated symptoms. A case study was conducted on three patients suffering from severe forms of pectus excavatum using modified taulinoplasty with two Pectus Up bars.Case descriptionThe patients were males, with an age of 15 years. Preoperatively, they underwent spirometry, an echocardiogram, and allergy tests. The procedure involved inserting two Pectus Up bars into the chest wall at the major sternal defect, allowing the implant to remain completely invisible. The procedure involved placing the sternal plate at the deepest point and anchored to the sternum with five self-tapping screws. The chest plate was then fixed to the bar using two screws.DiscussionThe use of Pectus Up was first reported in 2016 and has been a subject of scientific discussion and research. The double Pectus Up technique offers improved correction, increased stability, and reduced complications. However, it also presents challenges such as increased technical complexity and potential for prolonged operative times. Patient outcomes showed promising results in terms of short-term correction and long-term stability. The use of a double bar technique in the modified Taulinoplasty procedure is a key area of ongoing clinical research and innovation in pectus excavatum repair. Further studies will be needed, including more institutions that use this technique to validate our initial experience.

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Modified Nuss procedure for the treatment of pectus excavatum: Experience of 259 patients

Li¹,

Wang²,

Ji³

et al. 2023

Asian Journal of Surgery

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Transesophageal echocardiography during pectus excavatum correction in children: What happens to the heart?

Cited by 7 publications

References 30 publications

Systematic review of physiological and psychological outcomes of surgery for pectus excavatum supporting commissioning of service in the UK

Systematic review of physiological and psychological outcomes of surgery for pectus excavatum supporting commissioning of service in the UK

Case Report: Double Pectus Up in severe pectus excavatum, the new frontier of modified taulinoplasty

Modified Nuss procedure for the treatment of pectus excavatum: Experience of 259 patients

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