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Published in: Journal of Cardiothoracic Surgery 1/2017

Open Access 01-12-2017 | Research article

Outcome of surgical repair of Pectus Excavatum in adults

Authors: Ayman M. Shaalan, Ibrahim Kasb, Eman E. Elwakeel, Yusra A. Elkamali

Published in: Journal of Cardiothoracic Surgery | Issue 1/2017

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Abstract

Background

Pectus Excavatum (PEx) is the most common congenital chest wall deformity, accounting for over 90% of all chest wall deformities. Surgical correction is recommended because severe PEx can affect the physical and psychological development of patients. The aim of our study was to assess the impact of surgical repair of Pectus Excavatum in adults during hospital course and results after 1 year.

Methods

Prospective study was carried out on 86 adult patients aged ≥ 15 years, 52 males and 34 females (mean age was 26 ± 1.5 years). All cases were divided into two groups, group I: (15–25 years old) and group II: (> 25 years old). Preoperative, operative, and postoperative data were reviewed. Statistical analysis was performed.

Results

Statistical analyses revealed significant improvement postoperatively of cosmetic satisfaction (P-value < 0.0001), pain (P-value =0.0003), exertional dyspnea (p-value <0.05) and exercise tolerance. The degree of chest compression was significantly improved after surgical correction within 12 months and the estimated measurement postoperatively of Haller Index showed significant reduction (p-value <0.001). Patient satisfaction postoperatively was excellent in 77.9% of all cases.

Conclusion

Surgical correction of Pectus Excavatum using open technique in adults had excellent post-operative outcome in the short term follow up that encourage performing the procedure for all cases. Long term results need longer period for follow up. Etiology and predisposing factors still need further research.
Literature
1.
go back to reference Dong-Kun Z, Ji-Ming T, Xiao-Song B, et al. Surgical correction of 639 Pectus Excavatum cases via the Nuss procedure. J Thorac Dis. 2015;7(9):1595–605. Dong-Kun Z, Ji-Ming T, Xiao-Song B, et al. Surgical correction of 639 Pectus Excavatum cases via the Nuss procedure. J Thorac Dis. 2015;7(9):1595–605.
2.
go back to reference Dimeglio A, Canavese F. The growing spine: how spinal deformities influence normal spine and thoracic cage growth. Eur Spine J. 2012;21:64–70.CrossRefPubMed Dimeglio A, Canavese F. The growing spine: how spinal deformities influence normal spine and thoracic cage growth. Eur Spine J. 2012;21:64–70.CrossRefPubMed
3.
go back to reference Marissa KS, Jennifer LF, Kent TY, et al. Natural large-scale regeneration of rib cartilage in a mouse model. J Bone Miner Res. 2015;30(2):297–308.CrossRef Marissa KS, Jennifer LF, Kent TY, et al. Natural large-scale regeneration of rib cartilage in a mouse model. J Bone Miner Res. 2015;30(2):297–308.CrossRef
4.
go back to reference Jaroszewski D, Notrica D, McMahon L, et al. Current management of Pectus Excavatum: a review and update of therapy and treatment recommendations. J Am Board Fam Med. 2010;23:230–9.CrossRefPubMed Jaroszewski D, Notrica D, McMahon L, et al. Current management of Pectus Excavatum: a review and update of therapy and treatment recommendations. J Am Board Fam Med. 2010;23:230–9.CrossRefPubMed
5.
go back to reference Kotzot D, Schwabegger AH. Etiology of chest wall deformities-a genetic review for the treating physician. J Pediatr Surg. 2009;44:2004–11.CrossRefPubMed Kotzot D, Schwabegger AH. Etiology of chest wall deformities-a genetic review for the treating physician. J Pediatr Surg. 2009;44:2004–11.CrossRefPubMed
6.
go back to reference Goretsky MJ, Kelly RE Jr, Croitoru D, Nuss D. Chest wall anomalies: pectus excavatum and pectus carinatum. Adolesc Med Clin. 2004;15:455–71.CrossRefPubMed Goretsky MJ, Kelly RE Jr, Croitoru D, Nuss D. Chest wall anomalies: pectus excavatum and pectus carinatum. Adolesc Med Clin. 2004;15:455–71.CrossRefPubMed
7.
go back to reference Hyung J, Sook-Whan S, Jae J, Jae K, Hyun W, Young Pil W. How early can we repair pectus excavatum: the earlier the better? Eur J Cardiothorac Surg. 2012;42(4):667–72.CrossRef Hyung J, Sook-Whan S, Jae J, Jae K, Hyun W, Young Pil W. How early can we repair pectus excavatum: the earlier the better? Eur J Cardiothorac Surg. 2012;42(4):667–72.CrossRef
8.
go back to reference Creswick HA, Stacey MW, Kelly RE Jr, Gustin T, Nuss D, Harvey H, Goretsky MJ, Vasser E, Welch JC, Mitchell K, Proud VK. Family study of the inheritance of pectusexcavatum. J Pediatric Surg. 2006;41(10):1699–703.CrossRef Creswick HA, Stacey MW, Kelly RE Jr, Gustin T, Nuss D, Harvey H, Goretsky MJ, Vasser E, Welch JC, Mitchell K, Proud VK. Family study of the inheritance of pectusexcavatum. J Pediatric Surg. 2006;41(10):1699–703.CrossRef
9.
go back to reference Fokin AA, Steuerwald NM, Ahrens WA, Allen KE. Anatomical, histologic, and genetic characteristics of congenital chest wall deformities. Semin Thorac Cardiovasc Surg. 2009;9:44–57.CrossRef Fokin AA, Steuerwald NM, Ahrens WA, Allen KE. Anatomical, histologic, and genetic characteristics of congenital chest wall deformities. Semin Thorac Cardiovasc Surg. 2009;9:44–57.CrossRef
10.
go back to reference Kotzot D, Schwabegger AH. Etiology of chest wall deformities–a genetic review for the treating physician. J Pediatr Surg. 2009;9:2004–11.CrossRef Kotzot D, Schwabegger AH. Etiology of chest wall deformities–a genetic review for the treating physician. J Pediatr Surg. 2009;9:2004–11.CrossRef
11.
go back to reference Korlacki W, Janicka I, Dzielicka E. Difficulties and limitations in minimally invasive repair of pectus excavatum--6 years experiences with Nuss technique. Eur J Cardiothoracic surg. 2006;30(5):801–4.CrossRef Korlacki W, Janicka I, Dzielicka E. Difficulties and limitations in minimally invasive repair of pectus excavatum--6 years experiences with Nuss technique. Eur J Cardiothoracic surg. 2006;30(5):801–4.CrossRef
12.
go back to reference Fonkalsrud EW. Current management of pectus Excavatum. World J Surg. 2003;9:502–8.CrossRef Fonkalsrud EW. Current management of pectus Excavatum. World J Surg. 2003;9:502–8.CrossRef
13.
go back to reference Miyoung K, Ki Y, Hyung J, Hee-Young K, Eun-Young K, Yu W, Bo K, Bo K.andEun-Jung C. Development of new cardiac deformity indexes for PectusExcavatum on computed tomography: feasibility for pre- and post-operative evaluation. Yonsei Med J. 2009;50(3):385–90.CrossRef Miyoung K, Ki Y, Hyung J, Hee-Young K, Eun-Young K, Yu W, Bo K, Bo K.andEun-Jung C. Development of new cardiac deformity indexes for PectusExcavatum on computed tomography: feasibility for pre- and post-operative evaluation. Yonsei Med J. 2009;50(3):385–90.CrossRef
14.
go back to reference Tran N, Larry K, Paul M, Chung EH, Schwartz JD, Pursell I, Gehi AK. Lone atrial fibrillation is associated with pectus excavatum. Heart rhythm J. 2013;10(9):1263–9.CrossRef Tran N, Larry K, Paul M, Chung EH, Schwartz JD, Pursell I, Gehi AK. Lone atrial fibrillation is associated with pectus excavatum. Heart rhythm J. 2013;10(9):1263–9.CrossRef
15.
go back to reference Li T, Evan B, Mason S, Paul K, Marc F. Pectus excavatum: a cause of serious cardiac dysfunction and dysrhythmia. Americal journal of emergency medicine. 2015;33(9):1333. Li T, Evan B, Mason S, Paul K, Marc F. Pectus excavatum: a cause of serious cardiac dysfunction and dysrhythmia. Americal journal of emergency medicine. 2015;33(9):1333.
16.
go back to reference Canpolt U, Yalcin U, Sahiner L, Aytemir K. Case images: atrial fibrillation due to right atrial compression in a patient with pectus excavatum. Turk Kardiyol DA j. 2012;40(4):392.CrossRef Canpolt U, Yalcin U, Sahiner L, Aytemir K. Case images: atrial fibrillation due to right atrial compression in a patient with pectus excavatum. Turk Kardiyol DA j. 2012;40(4):392.CrossRef
17.
go back to reference Kelly RE. Pectus Excavatum: historical background, clinical picture, preoperative evaluation and criteria for operation. Semin Pediatr Surg. 2008;9:181–93.CrossRef Kelly RE. Pectus Excavatum: historical background, clinical picture, preoperative evaluation and criteria for operation. Semin Pediatr Surg. 2008;9:181–93.CrossRef
18.
go back to reference Krille S, Muller A, Steinmann C, Reingruber B, Weber P, Martin A. Self- and social perception of physical appearance in chest wall deformity. Body Image. 2012;9:246–52.CrossRefPubMed Krille S, Muller A, Steinmann C, Reingruber B, Weber P, Martin A. Self- and social perception of physical appearance in chest wall deformity. Body Image. 2012;9:246–52.CrossRefPubMed
19.
go back to reference Kelly RE, Cash TF, Shamberger RC, Mitchell KK, Mellins RB, Lawson ML, Oldham K, Azizkhan RG, Hebra AV, Nuss D, et al. Surgical repair of pectus excavatum markedly improves body image and perceived ability for physical activity: multicenter study. J Pediatrics. 2008;9:1218–22.CrossRef Kelly RE, Cash TF, Shamberger RC, Mitchell KK, Mellins RB, Lawson ML, Oldham K, Azizkhan RG, Hebra AV, Nuss D, et al. Surgical repair of pectus excavatum markedly improves body image and perceived ability for physical activity: multicenter study. J Pediatrics. 2008;9:1218–22.CrossRef
20.
go back to reference Kelly RE, Lawson ML, Paidas CN, Hruban RH. Pectus excavatum in a 112-year autopsy series: anatomic findings and the effect on survival. J Pediatr Surg. 2005;9:1275–8.CrossRef Kelly RE, Lawson ML, Paidas CN, Hruban RH. Pectus excavatum in a 112-year autopsy series: anatomic findings and the effect on survival. J Pediatr Surg. 2005;9:1275–8.CrossRef
21.
go back to reference Swanson JW, Avansino JR, Phillips GS, Yung D, Whitlock KB, Redding GJ, Sawin RS. Correlating Haller index and cardiopulmonary disease in pectusexcavatum. Am J Surg. 2012;9:660–4.CrossRef Swanson JW, Avansino JR, Phillips GS, Yung D, Whitlock KB, Redding GJ, Sawin RS. Correlating Haller index and cardiopulmonary disease in pectusexcavatum. Am J Surg. 2012;9:660–4.CrossRef
22.
go back to reference Wiliam R, David F, Sunil S. Systematic review of surgical treatment techniques for adult and pediatric patients with pectus excavatum. J Cardiothorac Surg. 2014;9:25.CrossRef Wiliam R, David F, Sunil S. Systematic review of surgical treatment techniques for adult and pediatric patients with pectus excavatum. J Cardiothorac Surg. 2014;9:25.CrossRef
23.
go back to reference Robicsek F, Fokin A. Surgical correction of pectus excavatum and carinatum. J cardiovasc Surg(Torino). 1999;40(5):725–31. Robicsek F, Fokin A. Surgical correction of pectus excavatum and carinatum. J cardiovasc Surg(Torino). 1999;40(5):725–31.
24.
go back to reference Genc O, Gurkok S, Gozubuyuk A, Dakak M, Caylak H, Yucel O. Repair of pectus deformities: experience and outcome in 317 cases. J Ann Saudi Med. 2006;26(5):370–4.CrossRef Genc O, Gurkok S, Gozubuyuk A, Dakak M, Caylak H, Yucel O. Repair of pectus deformities: experience and outcome in 317 cases. J Ann Saudi Med. 2006;26(5):370–4.CrossRef
25.
go back to reference Shin S, Goretsky MJ, Kelly RE Jr, et al. Infectious complications after the Nuss repair in a series of 863 patients. J Pediatr Surg. 2007;42:87–92.CrossRefPubMed Shin S, Goretsky MJ, Kelly RE Jr, et al. Infectious complications after the Nuss repair in a series of 863 patients. J Pediatr Surg. 2007;42:87–92.CrossRefPubMed
26.
go back to reference Nasr A, Fecteau A, Wales PW. Comparison of the Nuss and the Ravitch procedure for pectus excavatum repair: a meta-analysis. J pedi Surg. 2010;45(5):880–6.CrossRef Nasr A, Fecteau A, Wales PW. Comparison of the Nuss and the Ravitch procedure for pectus excavatum repair: a meta-analysis. J pedi Surg. 2010;45(5):880–6.CrossRef
Metadata
Title
Outcome of surgical repair of Pectus Excavatum in adults
Authors
Ayman M. Shaalan
Ibrahim Kasb
Eman E. Elwakeel
Yusra A. Elkamali
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Journal of Cardiothoracic Surgery / Issue 1/2017
Electronic ISSN: 1749-8090
DOI
https://doi.org/10.1186/s13019-017-0635-z

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