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

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

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

BACKGROUNDFunnel chest has a negative effect on adolescents and it has a strong effect on adolescents' psychological and behavior. This study aimed to investigate the psychological characteristics and factors that affect adolescents with funnel chest and to evaluate the relationship between the patients' age and their physiological and psychological health. We aimed to establish an age model for maximum surgery benefits for funnel chest patients to provide an objective basis for choosing surgery.

METHODSThe study adopted a general evaluation approach to assess the risk and benefits of minimally invasive surgery for funnel chest. The funnel chest index, the Symptom Checklist-90, and the Eysenck Personality Questionnaire were used as assessment tools to observe physiological and psychological features in funnel chest patients. A sample of 234 adolescents with funnel chest was selected from a third-grade class-A hospital in Beijing. Age groups were adopted as an independent variable, and other factors in funnel chest patients were dependent variables.

RESULTSThere was a significant difference in the relapse rate for funnel chest in the different age groups (χ(2) = 11.883, P = 0.008). There was a higher relapse rate in patients of ≤10 or ≥19 years old than in patients of 11-18 years old. There was a significant difference in the SCL-90 total score in the different age groups (F = 12.538, P = 0.0001), the patients older than 13 years had a higher score than those younger than 13 years in the SCL-90. There was a significant difference in the standard score of E (introversion/ extraversion) in the different age groups (F = 10.06, P = 0.0001). There was also a significance in the funnel chest index before surgery in the different psychological scales (P < 0.01), with a higher funnel chest index score associated with more obvious psychological trauma. Age and the number of variables, including the relapse rate, SCL-90 score, standard score of E, and standard score of N in the EPQ were significantly correlated (correlation indices were 0.402, 0.623, -0.505, and 0.473, respectively, P < 0.01).

CONCLUSIONSThere are higher complication rates after surgery and relapse rates when funnel chest patients are too young or too old. There is more obvious psychological trauma in patients with a high funnel chest index. Our results indicate that the best age for surgery for funnel chest is 14-16 years.

Adolescent ; Adult ; Age Factors ; Child ; Funnel Chest ; psychology ; surgery ; Humans ; Minimally Invasive Surgical Procedures ; Psychological Tests ; Psychology, Adolescent

Pectus excavatum is the common congenital chest wall deformity in children, and Nuss procedure is the conventional surgical treatment for this disease. Nuss procedure is superior to Ravitch correction for it is less harmful in terms of the surgical technique. However, Nuss procedure is associated with severe postoperative pain, thus adequate postoperative analgesia is important. In this review, factors that influence the postoperative pain after Nuss procedure, the pain managements, the related complications and the side effects of drugs are discussed.
Analgesia ; methods ; Child ; Child, Preschool ; Funnel Chest ; surgery ; Humans ; Pain, Postoperative ; etiology ; therapy

OBJECTIVE: To evaluate the safety and efficacy of modified technique for removing Nuss bar after Nuss procedure. METHODS: We reviewed 186 patients undergoing bar removal after repair of pectus excavatum with Nuss procedure at our institution from December 2008 to February 2012. All patients had unilateral incision (metallic stabilizers have been used on one side in all patients). Under general anesthesia with single lumen tracheal tube or laryngeal mask, with the patient lying down in supine position, the bar was pulled out along the thoracic wall without overturning or straightening. RESULTS: Totally 132 patients (71.0%) had the bar removed 2 years after the Nuss procedure, 1 (0.5%) removed within 1 year and 53 (28.5%) removed over 2 and half years. The operation time for bar removal was 9-20 (13.1 ± 3.4) min, and the operative blood loss was 3-20 (5.2 ± 2.7) mL. There was no hemorrhage. Three patients (1.6%) developed mild pneumothorax and none showed infection of incision after the operation. All patients were discharged 1 day after the surgery and followed up for 4-48 (21.4 ± 6.8) months. Recurrence was found in the one who which had the bar removed within 1 year (0.5%). CONCLUSION With modified procedures, Nuss bar can be easily and safely removed 2 years or longer after the Nuss operation. After removing the metallic stabilizer, the bar should be turned and then pulled out along the original surgical incision without bending or turning.
Adolescent ; Blood Loss, Surgical ; Child ; Child, Preschool ; China ; epidemiology ; Device Removal ; methods ; Female ; Funnel Chest ; surgery ; Humans ; Male ; Orthopedic Fixation Devices ; Pneumothorax ; epidemiology ; etiology ; Postoperative Complications ; epidemiology ; prevention & control ; Prostheses and Implants ; Sternum ; surgery ; Young Adult

PURPOSE: The aim of this prospective, double-blind, randomized study was to investigate the analgesic effects of low-dose ketamine on intravenous patient-controlled analgesia (IV-PCA) with fentanyl for pain control in pediatric patients following the Nuss procedure for pectus excavatum. MATERIALS AND METHODS: Sixty pediatric patients undergoing the Nuss procedure were randomly assigned to receive fentanyl (Group F, n=30) or fentanyl plus ketamine (Group FK, n=30). Ten minutes before the end of surgery, following the loading dose of each solution, 0.5 microg/kg/hr of fentanyl or 0.5 microg/kg/hr of fentanyl plus 0.15 mg/kg/hr of ketamine was infused via an IV-PCA pump (basal rate, 1 mL/hr; bolus, 0.5 mL; lock out interval, 30 min). Fentanyl consumption, pain score, ketorolac use, nausea/vomiting, ondansetron use, pruritus, respiratory depression, hallucination, dreaming, and parent satisfaction with pain control were measured throughout the 48 hours following surgery. RESULTS: The pain scores, ketorolac use, and fentanyl consumption of Group FK were significantly lower than in Group F (p<0.05). The incidence of nausea/vomiting and ondansetron use in Group FK was significantly lower than in Group F (p<0.05). There were no reports of respiratory depression, hallucination or dreaming. Parent satisfaction with pain control was similar between the two groups. CONCLUSION: We concluded that low-dose ketamine added to IV-PCA with fentanyl after the Nuss procedure in pediatric patients can reduce pain scores, consumption of fentanyl, and incidence of nausea/vomiting without increasing side effects.
Analgesia, Patient-Controlled/*methods ; Analgesics/*therapeutic use ; Child ; Double-Blind Method ; Female ; Fentanyl/*therapeutic use ; Funnel Chest/surgery ; Humans ; Injections, Intravenous ; Ketamine/*therapeutic use ; Male ; Pain, Postoperative/drug therapy

OBJECTIVETo evaluate the short-term effect and experience of Nuss procedure on 120 cases of patients with pectus excavatum.

METHODSThoracoscopy assisted Nuss procedure with different ways of anesthesia were applied to 120 cases of patients with pectus excavatum, including 7 cases of recurrence after traditional surgical procedure (6 cases) and Nuss method (another one). The patients ranged in age from 2.5 to 43 (mean 14.1) years and in Haller index from 2.91 to 29. Of the 120, 73 had symmetric and 47 had asymmetric pectus excavatum. The Nuss procedure is performed with general anesthesia and a convex steel bar is inserted under the sternum with thoracoscopy through small bilateral thoracic incisions. The steel bar is inserted with the convexity facing posteriorly, and when it is in position, the bar is turned over, thereby correcting the deformity.

RESULTSThe operation was successfully accomplished without severe complications in all the 120 cases. The mean operative time was 58 minutes and the mean volume of blood loss was 30 ml. 103 patients had one bar inserted while the other 17 cases with more extremely diffuse depression required 2 or even 3 bars to get a satisfactory correction. Such methods as modifications to the fixing points and the shape of the bar, partial osteotomy, were developed to deal with asymmetric ones.

CONCLUSIONThe Nuss procedure is a minimally invasive technique for correction of pectus excavatum. It can lead to a satisfactory outcome and surgical time is less.

Adolescent ; Adult ; Child ; Child, Preschool ; Female ; Funnel Chest ; surgery ; Humans ; Male ; Orthopedic Procedures ; methods ; Thoracoscopy ; Young Adult

PURPOSE: Breast augmentation is one of the common procedures in plastic surgery today. The shape, size and insertion plane of the implant is decided preoperatively by physical examination of the breast. Pectus excavatum is one of the most common anomalies of chest wall, characterized by a depression of the anterior chest wall. For patients with a mild type of pectus excavatum, the main purpose of the treatment is aesthetic rather than functional improvement. Two most surgical treatment options for skeletal deformity are the Ravitch technique and minimally invasive Nuss repair. Other options for soft tissue repair are implant insertion and autologous soft tissue augmentation. We performed a surgical operation with Nuss procedures and breast augmentation for a patient with mild pectus excavatum and hypoplastic breast. METHODS: A 32 year-old female was presented with hypoplastic breast. Preoperative chest CT was performed, showing pectus excavatum. After Nuss procedure, we inserted saline implant(275cc textured round breast implant, moderate profile) submuscularly to restore adequately projected breast. RESULTS: Patient's postoperative course was uneventful without any complication. After 6 months of follow-up period, the patient had an excellent result, with high patient satisfaction and no complications. CONCLUSION: For patients with a mild type of pectus excavatum, who do not have cardiopulmonary symptoms and requires for aesthetic improvement, this simple approach with Nuss procedure and breast augmentation achieves excellent aesthetic correction with low complication rate and high patient satisfaction.
Breast ; Breast Implants ; Congenital Abnormalities ; Depression ; Female ; Follow-Up Studies ; Funnel Chest ; Humans ; Patient Satisfaction ; Physical Examination ; Surgery, Plastic ; Thoracic Wall ; Thorax