Cardiac decompression and right ventricular function improvement after bar removal in patients with pectus excavatum.

Pectus excavatum, the most frequent malformation of the chest wall, has been related to cardiac compression and exercise intolerance. Cardiac outcomes after minimally invasive repair of pectus excavatum with retrosternal implants, particularly after removal (> 2 years postoperative) are generally unknown. We evaluated stress echocardiography outcomes before repair and after bar removal.

Proposing the Retrosternal Angle as a Diagnostic Measure for Banana Sternum in Pectus Excavatum.

Background/purpose: Anteriorly convex sternum in pectus excavatum, also known as banana sternum (BS), influences decision-making during repair and, especially, the need to cross bars. However, the definition of BS remains subjective. Thus, we aim to propose the retrosternal angle (RSA) as a diagnostic measure for the discrimination of BS.

Novel techniques and future developments in minimally invasive pectus repair.

After the paradigm shift in the treatment of excavated deformities caused by the introduction of the Nuss technique in 1998, several innovative technical modifications and new treatment modalities have radically changed the surgical approach of pectus excavatum in the last couple of years. These new trends attain different topics. On one hand, the use of three-dimensional (3D) printing and implant customization surge as a possibility for a wider audience as 3D printers become available with lower costs.

The role of 3D printing in chest wall reconstruction.

Technology is advancing fast, and chest wall surgery finds particular benefit in the broader availability of three-dimensional (3D) reconstruction and printing. An increasing number of reports are being published on the use of these resources in virtual 3D reconstructions of chest walls in computed tomography (CT) scans, virtual surgeries, 3D printing of real-size models for surgical planning, practice, and education, and of note, the manufacture of customized 3D printed implants, changing the fundamental conception from a surgery that fits all, to a surgery for each patient. In this review, we explore the evidence published on simple chest wall reconstruction, including the use of 3D technology to assist in the improvement of the repair of the most frequent chest wall deformities: pectus excavatum and carinatum.

Unsophisticated assessment of the cardiopulmonary function in patients with pectus excavatum using the six minute walk test.

Background: We explored whether the maximum predicted walking distance, assessed with six-minute walk test (6MWT) and reflecting submaximal functional exercise capacity, is decreased among patients with pectus excavatum (PEX).

Methods: This study comprised a retrospective analysis of patients with PEX who underwent a 6MWT for the assessment of functional capacity. The maximum distance walked was recorded and compared to reference values established for different populations, including a young and healthy South American population.

Lessons Learned after 176 Patients Treated with a Standardized Procedure of Thoracoscopic Cryoanalgesia during Minimally Invasive Repair of Pectus Excavatum.

Background: Intrathoracic intercostal cryoanalgesia (Cryo) during minimally invasive repair of pectus excavatum (MIRPE) reports have been related to improved pain management, although its extent differs amongst studies. We aimed to report our experience using a standardized perioperative approach including Cryo during MIRPE, and compare our actual results with those of a previous thoracic epidural analgesia (TE) cohort. Lessons learned are summarized.

Novel index to estimate the cephalocaudal extent of the excavation in pectus excavatum: The Titanic index.

Background/purpose: Quantification of the severity of pectus excavatum deformities is currently performed using the Haller index (HI) and the Correction index (CI), amongst others. However, most indexes characterize the severity at the point of maximum excavation. We present a new index, the Titanic index (TI), aimed at the appraisal of the cephalocaudal extent of the excavation and its potential clinical use.

Short communication: ultrasound-guided percutaneous cryoanalgesia of intercostal nerves for uniportal video-assisted thoracic surgery.

Background: Pain after thoracic surgery impairs lung function and increases the rate of postoperative pulmonary complications. Ultrasound-guided percutaneous cryoanalgesia of intercostal nerves constitutes a valid option for adequate postoperative analgesia. A key issue for a successful cryoanalgesia is placing the cryoprobe tip close to the intercostal nerve.

Remote treatment of pectus carinatum (Telepectus) during the COVID-19 pandemic.

Background/purpose: To report telemedicine's feasibility and satisfaction rates for treating patients with pectus carinatum using a dynamic compressor system. We analyzed treatment adherence in comparison with the previous, non-pandemic year.

Materials And Methods: Retrospective analysis including patients with pectus carinatum under treatment with a dynamic compressor system using telemedicine at the chest wall centers from two hospitals, private and public, between April and July 2020.

Usefulness of strain cardiac magnetic resonance for the exposure of mild left ventricular systolic abnormalities in pectus excavatum.

Background: Systolic dysfunction in pectus excavatum (PEX) is usually very subtle and mainly focused on the right ventricle (RV), leading to normal or unremarkable cardiac imaging findings unless involving exercise stress.

Objectives: We evaluated systolic function in PEX using longitudinal strain cardiac magnetic resonance (CMR), a validated parameter for the assessment of the systolic deformation of subendocardial fibers.

Methods: This prospective registry comprised consecutive patients with PEX who were referred to CMR to define treatment strategies or to establish surgical candidacy.

Erratum: Diastolic and Systolic Cardiac Dysfunction in Pectus Excavatum: Relationship to Exercise and Malformation Severity.

[This corrects the article DOI: 10.1148/ryct.2020200011.

Diastolic and Systolic Cardiac Dysfunction in Pectus Excavatum: Relationship to Exercise and Malformation Severity.

Purpose: To explore stress echocardiographic findings among patients with pectus excavatum (PEX) and their relationship with malformation severity.

Materials And Methods: A prospective registry involving consecutive patients with a diagnosis of isolated PEX referred to undergo chest CT and stress echocardiography to evaluate surgical candidacy and/or to define treatment strategies was developed. Malformation indexes were evaluated using chest CT.

Surgical Planning, Simulation, and Prosthesis Customization for Complex Chest Wall Malformations.

Despite the emergent application of 3-dimensional technology for thoracic reconstructions, reports regarding its use for the resolution of the heterogeneous subgroup of complex chest wall malformations are lacking. We aim to report a novel, standardized process of personalized repair of complex chest wall malformations comprising multidisciplinary, comprehensive surgical planning; surgical simulation on a 3-dimensionally printed scale model of the area of interest; manufacturing of customized prostheses; and surgical repair according to plan. We propose this therapeutic strategy for the resolution of such a wide variety of chest wall deformities to reduce improvisation and enhance outcomes.

From bench to bedside: 3D reconstruction and printing as a valuable tool for the chest wall surgeon.

Background/purpose: The development of computer-aided design/manufacturing and digital image technology shows promise to revolutionize several medical and surgical fields. In this context, we propose a different approach for minimally invasive repair of pectus excavatum (MIRPE) including preoperative planning, ambulatory template fitting, and implant customization.

Methods: We prospectively collected data on 130 consecutive patients who underwent a novel process of implant customization for MIRPE between November 2015 and September 2019 at our institution.

Thoracoscopic cryoanalgesia: A new strategy for postoperative pain control in minimally invasive pectus excavatum repair.

Objective: Recent publications report early discharge and low opioid requirements after minimally invasive pectus excavatum repair treated with bilateral intercostal nerve cryoablation. Our aim is to report our initial experience with this technique.

Material And Methods: Retrospective analysis of medical records of patients undergoing bilateral thoracoscopic cryoanalgesia during minimally invasive pectus excavatum repair within our institution from September 2018 to March 2019.

Safety-string: A handy maneuver to control pectus bar removal bleeding complications.

The pectus bar removal procedure is often considered a simple, straightforward surgery with a low incidence of complications. However, life-threatening bleeding complications have been reported requiring major measures for hemostatic control. Our objective is to share a simple maneuver that our group has systematically included in the bar removal procedure to facilitate bleeding control in case hemorrhage occurs.

Lessons Learned After 101 Cases of Single-Site Magnetic-Assisted Cholecystectomy in Children.

Background / Purpose: The aim of this report is to present our experience with a magnetic-assisted single-site cholecystectomy technique ("magnachole") in pediatric patients.

Methods: We performed a retrospective chart review of all patients who underwent magnachole between 2009 and 2019. We evaluated patients' demographics, diagnosis, operative time, complications, conversion rate and length of stay.

Pectus carinatum: When less is more.

Awareness of pectus carinatum has increased among the medical community over the last several decades, as innovative options for nonsurgical treatments have become more widely known. Management alternatives have shifted from open resective to minimally invasive strategies, and finally, to reshaping the chest using both surgical and non-surgical modalities. We aim to review the evolution of the diagnosis and treatment of pectus carinatum up to its current management.

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

Purpose: Image acquisition protocols and reports in patients with pectus excavatum (PEX) differ significantly from routine examinations, and no imaging modality can enable a comprehensive assessment of PEX severity and cardiac impact within a single examination. We therefore attempt to establish recommendations about preoperative imaging in patients with PEX.

Method: Chest computed tomography (CT), stress echocardiography (Echo), and cardiac magnetic resonance (CMR) allow the evaluation of specific information regarding structural and functional characteristics of vital importance to assess surgical candidacy and define surgical strategies.

Sternal torsion in pectus excavatum is related to cardiac compression and chest malformation indexes.

Background/purpose: The role of sternal torsion (ST) in patients with pectus excavatum (PEX) is unknown. We evaluated the relationship between ST and both chest malformation and cardiac compression (CC) indexes.

Methods: We included consecutive patients with PEX who underwent chest computed tomography and cardiac magnetic resonance (CMR) to define surgical candidacy.

Impact of pectus excavatum on cardiac morphology and function according to the site of maximum compression: effect of physical exertion and respiratory cycle.

Aims: Previous studies have demonstrated diverse cardiac manifestations in patients with pectus excavatum (PEX), although mostly addressing morphological or physiological impact as separate findings. Using multimodality imaging, we evaluated the impact of PEX on cardiac morphology and function according to the site of maximum compression, and the effect of exertion and breathing.

Methods And Results: All patients underwent chest computed tomography, cardiac magnetic resonance (CMR), and stress echocardiography (echo) in order to establish surgical candidacy.

Evaluation of pectus excavatum indexes during standard cardiac magnetic resonance: Potential for single preoperative tool.

Purpose: Preoperative assessment of patients with pectus excavatum (PE) demands evaluation of malformation indexes, generally with chest computed tomography (CT). In addition, assessment of the cardiac impact of sternal depression has become a rule in high referral centers, thus requiring two independent imaging modalities and use ionizing radiation in a very young population. The objective of this study was to explore the agreement between chest CT and standard cardiac MR (CMR) for the evaluation of chest wall malformation indexes.