Children's Hospital of The King's Daughters, Norfolk, VA, USA; Eastern Virginia Medical School, Norfolk, VA, USA; Old Dominion University, Norfolk, VA, USA; Virginia Consortium Program in Clinical Psychology, Norfolk, VA, USA.
Published: April 2021
AI Article Synopsis
Article Abstract
Background/purpose: Evaluate the safety of sternal elevation (SE) used selectively before creating the substernal tunnel during the Nuss procedure.
Methods: An IRB-approved (01-05-EX-0175-HOSP), single institution, retrospective review was performed (1/1/1997-11/20/2017). Primary and secondary Nuss repairs (i.e., previous Nuss, Ravitch, thoracotomy, or sternotomy) are included. SE use, cardiac injuries, and pectus bar infections are reported. Chi square and Fisher's exact test (FE) were used (critical p < .05).
Results: 2037 patients [(80% male; mean age 15.2 years (SD = 4.4, range 3-46); mean Haller index (HI) 5.3 (SD = 5.7, range 1.73-201)] underwent Nuss repair. SE was used before creating the substernal tunnel in 171 (8.4%): 160 (8.2%) of 1949 primary and 11 (12.5%) of 88 secondary repairs. SE use increased significantly [χ(2) = 118.93; p < .001] over time and with increasing HI [χ(3) = 59.9; p < .001]. No cardiac injuries occurred in primary repairs but two occurred in patients with previous sternotomy. Infection rates were not different with (2.9%) or without SE (1.8%) [χ(1) =1.14; p = .285] and not higher with off-label VB (1.5%) versus other SE techniques (3.8%) [FE, p = .65)].
Conclusion: Selective use of sternal elevation before substernal dissection during the Nuss procedure is safe but may not prevent cardiac injuries in patients with previous sternotomy. Infection rates were not increased with SE.
Introduction: Although myocardial injury is common after blunt chest trauma, tricuspid valve injury associated with traumatic atrial septal defect resulting in acute hypoxia is an infrequent event. We report an unusual case of blunt chest trauma referred to us for unexplained hypoxemia, emphasizing the unusual nature of injury and the importance of comprehensive cardiac evaluation in such cases.
Case Report: A 35-year-old male presented to the emergency department after falling from a tree from an approximate height of 15 feet.
A 78-year-old female presented with a history of left atrial myxoma resection 12 years before presentation. The initial surgery involved a median sternotomy and cardiopulmonary bypass for tumor excision. Sternal closure was achieved using six titanium wires, with the lowermost wire noted to be slightly elevated from the sternum immediately post-operation.
Background: Central venous catheter (CVC) is often used in the perioperative management of esophageal cancer. The position of the CVC tip has been reported to shift with body positioning and, although infrequent, may traverse into the azygos vein arch. Herein, we describe a case where a migrated CVC tip in the azygous vein arch was identified during esophageal cancer surgery, preventing CVC dissection concurrent with azygous vein arch resection.
: Minimally invasive cardiac surgery is often avoided in patients with obesity due to exposure and surgical access concerns. Nonetheless, these patients have elevated periprocedural risks. Minimally invasive transaxillary aortic valve surgery offers a sternum-sparing "nearly no visible scar" alternative to the traditional full sternotomy.
Objectives: Instability in the conventional, unilateral frame crane system occurs when greater sternal elevation forces are required, which potentially limits optimal sternal elevation during Nuss repair of the pectus excavatum. A bilateral frame setup was subsequently developed. We hypothesized that increasing the retractor's stability with the bilateral frame crane system would yield superior sternal elevation, as reflected by a greater lift of the anterior chest wall.
