OBJECTIVE: To identify the risk factors associated with the development of post-Nuss procedure scoliosis in pectus excavatum patients and to establish a relevant predictive model. METHODS: A retro-spective review was conducted on pectus excavatum patients who underwent Nuss procedure in Department of Thoracic Surgery at Beijing Jishuitan Hospital between January 2018 and February 2023. We gathered the patient demographic information (including age, sex, height, weight, and body mass index) and diagnostic imaging results (echocardiogram, chest CT scan, full-spine radiography, and PA/lateral chest X-rays), and measurements of Haller index, asymmetry index, sternal torsion angle (STA) index, and Cobb angle changes. The risk of post-Nuss procedure scoliosis was assessed. Cox regression analysis was performed to identify independent risk factors for scoliosis development in the pectus excavatum patients. Based on the results of the Cox regression analysis, a risk prediction model was established, and its specific predictive performance was assessed through internal cross-validation. RESULTS: A total of 59 pectus excavatum patients who underwent Nuss procedure were included after applying inclusion and exclusion criteria. The median follow-up duration was 6.84 months, and the follow-up results showed significant improvements in Haller index, STA index, and asymmetry index postoperatively. Twelve patients developed scoliosis 3 months after Nuss procedure, while 47 patients did not, the incidence of scoliosis was 20.3%. Cox regression analysis identified preoperative pulmonary artery hypertension and preoperative asymmetry index as independent risk factors for post-Nuss procedure scoliosis. A predictive model was constructed based on single-factor Cox regression analysis results, incorporating age, height, weight, body mass index, preoperative pulmonary artery hypertension, preoperative Haller index, STA index, asymmetry index, and Cobb angle. The receiver operating characteristic (ROC) curve was plotted, and the area under the curve (AUC) for the overall predictive model was calculated to be 0.995. A calibration curve demonstrated good alignment between predicted values and actual values. CONCLUSION Nuss procedure achieved favorable clinical outcomes. However, postoperative scoliosis emerged as a significant complication with a high incidence rate. Pulmonary artery hypertension and asymmetry index were independent predictors of post-Nuss procedure scoliosis. The predictive model developed in this study demonstrated robust performance in estimating the risk of postoperative scoliosis.
Humans ; Funnel Chest/surgery* ; Scoliosis/etiology* ; Child ; Male ; Female ; Adolescent ; Risk Factors ; Young Adult ; Postoperative Complications/epidemiology* ; Retrospective Studies ; Proportional Hazards Models

Echocardiography, Three-Dimensional ; Funnel Chest/surgery* ; Humans ; Ventricular Dysfunction, Right/diagnostic imaging* ; Ventricular Function, Right

To study the methods and principles for simultaneous treatment in the children with pectus excavatum (PE) combined with congenital cardiothoracic diseases.
 Methods: The medical records of all children, who underwent simultaneous repair of PE combined with congenital cardiothoracic diseases, were retrospectively reviewed in Hunan Children's Hospital from January 2007 to September 2018. The patients were divided into a PE combined with congenital heart disease (CHD) group (n=17) and a PE combined with thoracic disease group (n=10). The repair with a custom-made sternal lifting device, a Nuss repair, were performed in the treatment of PE, and the correction of the CHD was performed by heart open surgery using cardiopulmonary bypass (through sternotomy or right infra-axillary thoracotomy) or by transcatheter closure under echocardiography or X-ray-guided percutaneous intervention in the PE combined with CHD group. The children in the PE combined with thoracic disease group underwent thoracic surgery plus Nuss procedure concurrently.
 Results: All 27 pediatric patients underwent simultaneous repair of the PE combined with congenital cardiothoracic diseases. In the PE combined with CHD group, the duration of hospital stay ranged from 8.0 to 25.0 (13.2±4.8) days. Two patients had delayed healing of the surgical wound and 1 patient developed a small left pleural effusion postoperatively. In the PE combined with thoracic disease group, the duration of hospital stay ranged from 10.0 to 34.0 (19.9±7.5) days. One patient was complicated with chylothorax and 2 patients were complicated with pleural effusionin. The treatment for the patients in the 2 groups was satisfactory. No severe complications like surgical death, severe bleeding, chest organ injuries, and implant rejections were observed.
 Conclusion: According to the characteristics of patients, individualized programs should be selected in order to correct children's PE combined with congenital cardiothoracic diseases in the same period, which are safe, effective and can avoid the risk of multiple operations and anesthesia, and can reduce the financial burden of family.
Cardiac Surgical Procedures ; Child ; Funnel Chest ; surgery ; Heart Defects, Congenital ; Humans ; Minimally Invasive Surgical Procedures ; Retrospective Studies ; Sternotomy ; Treatment Outcome

Robotically assisted mitral valve repair has proven its efficacy during the last decade. The most suitable approach for patients with difficult anatomies, such as morbid obesity, sternal deformities, cardiac rotation, or vascular anomalies, represents a current challenge in cardiac surgery. Herein, we present the case of a 71-year-old patient affected by severe degenerative mitral valve regurgitation with pectus excavatum and a right aortic arch with an anomalous course of the left subclavian artery who was successfully treated using a Da Vinci–assisted approach.
Aged ; Aorta, Thoracic ; Congenital Abnormalities ; Funnel Chest ; Humans ; Mitral Valve Insufficiency ; Mitral Valve ; Obesity, Morbid ; Subclavian Artery ; Thoracic Surgery

OBJECTIVE: To review the experience with Wang procedure for treatment of pectus excavatum in young children. METHODS: The clinical data of 21 children with a mean age of 3.3 ± 1.1 years (ranging from 1.5-6 years) undergoing Wang procedure for pectus excavatum were analyzed. A longitudinal incision (1 to 2 cm) was made in the front of the xiphoid, and two tunnels were created using steel bars beneath the muscles on two sides of the chest wall. The fibrous tissue between the diaphragm and the sternum was dissociated, and the steel wires were sutured through the deformed chest wall. After the steel bar was placed in the tunnels, the wires were pulled and fixed in the middle of the bar, and the incision was sutured. RESULTS: All the operations were performed using 3 wires and 1 steel bar. The operation time was 25 to 51 (38.1 ± 9.6) min with an intraoperative bleeding volume of 5 to 10 (7.1±1.5) mL. The time of hospitalization of the patients ranged from 6 to 10 days (mean 8.1±1.3 days). In all the patients, the incision healed smoothly without serious pain or obvious complications. All the patients were followed up for 1 to 13 months after the operation. During the follow- up, no recess recurred and no such complications as bar displacement or transposition occurred. According to the evaluation criteria after pectus excavatum operation, 13 cases had a total score of 9, and 8 had a total score of 8. The overall effect was satisfactory, and there were no cases rated as basically satisfactory or unsatisfactory. CONCLUSIONS Wang procedure is a good option for treatment of pectus excavatum in young children.
Bone Wires ; Child ; Child, Preschool ; Diaphragm ; Funnel Chest ; surgery ; Humans ; Internal Fixators ; Operative Time ; Orthopedic Procedures ; instrumentation ; methods ; Retrospective Studies ; Thoracic Wall ; Treatment Outcome ; Xiphoid Bone ; surgery

Pectus excavatum (PE) is known as one of the most common congenital deformities of the anterior chest wall. The Nuss procedure is an effective surgical therapy to correct PE. Here, we report a case of recurrent cardiac tamponade due to hemopericardium that occurred after 16 months following the Nuss procedure. The cause of recurrent hemopericardium was thought to be local, repetitive irritation of the pericardium by the Nuss steel bar. We should keep in mind that this serious complication can occur after the Nuss procedure, even in the late phase.
Cardiac Tamponade ; Congenital Abnormalities ; Funnel Chest ; Pericardial Effusion ; Pericardium ; Steel ; Thoracic Wall

BACKGROUND: The nonsurgical treatment of chest wall deformity by a vacuum bell or external brace is gradual, with correction taking place over months. Monitoring the progress of nonsurgical treatment of chest wall deformity has relied on the ancient methods of measuring the depth of the excavatum and the protrusion of the carinatum. Patients, who are often adolescent, may become discouraged and abandon treatment. METHODS: Optical scanning was utilized before and after the intervention to assess the effectiveness of treatment. The device measured the change in chest shape at each visit. In this pilot study, patients were included if they were willing to undergo scanning before and after treatment. Both surgical and nonsurgical treatment results were assessed. RESULTS: Scanning was successful in 7 patients. Optical scanning allowed a visually clear, precise assessment of treatment, whether by operation, vacuum bell (for pectus excavatum), or external compression brace (for pectus carinatum). Millimeter-scale differences were identified and presented graphically to patients and families. CONCLUSION: Optical scanning with the digital subtraction of images obtained months apart allows a comparison of chest shape before and after treatment. For nonsurgical, gradual methods, this allows the patient to more easily appreciate progress. We speculate that this will increase adherence to these methods in adolescent patients.
Adolescent ; Braces ; Congenital Abnormalities* ; Funnel Chest ; Humans ; Pectus Carinatum ; Pilot Projects* ; Thoracic Wall* ; Thorax* ; Vacuum

OBJECTIVE: In pectus excavatum patients, Nuss procedure provides excellent cosmetic results, but it cause hypoxemia and hypercarbia by the reduction of alveolar ventilation due to severe thorax expansion and pain after operation. This study was designed to evaluate the effect of different oxygen flow rates via a nasal cannula in recovery room after correction of pectus excavatum by Nuss procedure. METHODS: Forty patients (3–12 years old) undergoing pectus excavatum repair were randomly assigned and divided into two groups. Patients were given 200 mL/kg/min flow of 100% oxygen (group 1) and 100 mL/kg/min flow of oxygen (group 2) via nasal cannula in the recovery room. Arterial blood gas analysis and peripheral oxygen saturation were measured at arrival and after 5, 10, 15, and 30 minutes in the recovery room. RESULTS: In group 1 compared with group 2, decrease of PaCO2 (partial pressure of CO2 in arterial blood) accumulation was observed in 5, 10, and 15 minutes. Arterial oxygen pressure (PaO2) difference was not significant between the group. But, in comparison within groups, PaO2 level was significantly higher at 5, 10, 15, and 30 minutes than just after arrival at the recovery room. In both group, heart rate and systolic blood pressure were no significant difference. CONCLUSION: We recommend that 200 mL/kg/min flow of 100% oxygen should be administered to patients who were taken Nuss procedure for prevention of hypoxemia and hypercarbia in recovery rooms.
Anoxia ; Blood Gas Analysis ; Blood Pressure ; Catheters* ; Funnel Chest* ; Heart Rate ; Humans ; Oxygen* ; Recovery Room* ; Thorax ; Ventilation

The IgG subclass deficiency is defined as a significant decrease in the serum concentrations of one or more subclasses of IgG in a patient whose total IgG concentration is normal. IgG subclass deficiency can predispose to recurrent sinopulmonary infections. A 29-year-old female patient with a 4-year history of bronchial asthma presented with cough, sputum, dyspnea, and recurrent respiratory infections. She had frequently been treated with antibiotics and systemic steroids for recurrent respiratory infections and acute asthma exacerbations. Chest X-ray and computed tomography showed pectus excavatum and bronchial wall thickening without lung parenchymal abnormalities. On immunological evaluation, she was found to have a low serum IgG3, with normal total IgG concentration. Under diagnosis of selective IgG3 deficiency, she was started on monthly infusions of intravenous immunoglobulin (IVIG) therapy. The frequency and severity of respiratory infections and acute asthma exacerbations were markedly decreased during 3 years of IVIG therapy. Our case report suggests that a patient who has underlying selective IgG3 deficiency and asthma may benefit from IVIG therapy as this can significantly reduce the incidence and severity of recurrent respiratory infections and acute asthma exacerbations.
Adult ; Anti-Bacterial Agents ; Asthma* ; Cough ; Diagnosis ; Dyspnea ; Female ; Funnel Chest ; Humans ; IgG Deficiency ; Immunization, Passive* ; Immunoglobulin G* ; Immunoglobulins* ; Immunoglobulins, Intravenous ; Incidence ; Lung ; Respiratory Tract Infections* ; Sputum ; Steroids ; Thorax

BACKGROUND: Pectus excavatum (PE) and pectus carinatum (PC) are the most common chest wall deformities. In this study, we aimed to characterize how patients obtained information about these deformities, as well as patients' family history, associated medical problems, and postoperative satisfaction after the Nuss and Abramson procedures. METHODS: This cross-sectional retrospective study included patients who were operated by a single surgeon between 2006 and 2013. Follow-up calls were made after approval of our institution's ethics committee. We reached 207 of the 336 PE patients (61.6%) and 73 of the 96 PC patients (76%). RESULTS: The majority of the patients were male (85% of the PE patients and 91.8% of the PC patients). The age of diagnosis of PE was 14.52+/-0.51 years and the age at the time of operation was 17.89+/-0.42 years; for PC patients, the corresponding ages were 15.23+/-0.55 years and 16.77+/-0.55 years, respectively. A total of 70% of the PE patients and 63.8% of the PC patients obtained information about pectus deformities through the Internet. In 27.1% of the PE patients with an associated anomaly, 57.1% (n=13) had scoliosis, while 41.1% of the PC patients with an associated anomaly had kyphosis (n=5). Postoperative satisfaction, as evaluated on a scale from 0 to 10, was 8.17+/-0.15 for PE patients and 8.37+/-0.26 for PC patients. The postoperative pain duration was 51.93+/-5.18 days for PE patients and 38.5+/-6.88 days for PC patients. CONCLUSION: In this study, we found that most patients with pectus deformities were male. The Internet was an important resource for patients to learn about their deformities. Family history and associated anomalies were identified as important aspects for consideration in the clinical setting. The patients reported high levels of postoperative satisfaction, and pain management was found to be one of the most important elements of postoperative care.
Congenital Abnormalities ; Diagnosis ; Ethics Committees ; Follow-Up Studies ; Funnel Chest* ; Humans ; Internet ; Kyphosis ; Male ; Pain Management ; Pain, Postoperative ; Patient Satisfaction* ; Postoperative Care ; Retrospective Studies ; Scoliosis ; Thoracic Wall