Influence of Nuss surgical operation for pectus excavatum on electrocardiogram abnormality considering anatomical severity as indicated by Haller index acquired by computed tomography and age

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
N Funabashi ◽  
Y Kobayashi
Keyword(s):  
Pectus Excavatum ◽  
Minimal Invasive ◽  
P Wave ◽  
Invasive Technique ◽  
Nuss Procedure ◽  
P Waves ◽  
Sinus Arrhythmia ◽  
Haller Index ◽  
Unenhanced Ct ◽  
Before And After

Abstract Background Pectus excavatum (PEX) is a depression of the sternum relative to costal cartilages and sometimes depress heart anatomically which cause abnormal ECG change. Nuss operation is minimal invasive technique for PEX repair. Purpose We speculated this Nuss operation would improve these ECG abnormalities. We also considered the Haller index (HI) and age to these influences. HI is an anatomical severity indicator of PEX calculated from CT. Methods A total of 17 patients (14 male, 12±6 years), who underwent Nuss operation for PEX, underwent unenhanced CT and ECG before and after the Nuss operation. Results All Nuss operation was successfully performed. On CT, HI was significantly improved from 5.62±2.29 to 3.29±0.65 (P=0.0002). A P wave with a negative portion >1 mm deep and >40 ms duration in V1 lead, incomplete right bundle branch block (RBBB), sinus arrhythmia, and right-axis deviation of a QRS wave were diagnosed in 15, 6, 12, and 5 patients, respectively. Comparing before with after Nuss operation, there were no significant differences of the degree of electrical axis of QRS waves, the degree of electrical axis of P waves, or the PQ interval, respectively (All P=NS). Absolute values of voltage of a negative portion of the P wave in V1 lead was significantly improved after the operation (1.55±1.25 vs 0.76±0.91mm, P<0.001). Among 12 patients with sinus arrhythmia, only one patient improved to that without. Among 6 patients with incomplete RBBB, only one patient improved to that without. The correlation coefficient (CC) between “values of the improvement of negative portion of the P wave in V1 lead after the operation” and “HI before operation” was 0.305 (P<0.05). The CC between “absolute values of the improvement of negative portion of the P wave in V1 lead after the operation” and “age at the operation” was −0.216 (P<0.05). Conclusion In patients with PEX, successful Nuss operation could achieve improvement of negative portion of the P wave in V1 lead positively correlated with “HI before operation” and negatively correlated with “age”. Nuss procedure would be more effective to abnormal ECG change, when anatomical severity is severer or age is younger. Improvement of negative P wave Funding Acknowledgement Type of funding source: None

Abstract 13730: Electrical Axes of P and T but Not QRS Waves on ECG Are New Indicators of Successfulness of the Nuss Operation for Pectus Excavatum Considering Anatomical Severity as Indicated by the Haller Index Acquired by CT

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Nobusada FUNABASHI ◽  
Yoshio Kobayashi
Keyword(s):  
Pectus Excavatum ◽  
Correlation Coefficients ◽  
P Wave ◽  
Invasive Technique ◽  
P Waves ◽  
Haller Index ◽  
Before And After ◽  
Group 2 ◽  
Group 1 ◽  
T Waves

Introduction: Pectus excavatum (PEX) is a depression of the sternum which can physically constrict the heart and cause abnormal ECGs. The Nuss operation is a minimally invasive technique for PEX repair. Hypothesis: As right (RA) and left atria (LA) are compressed in PEX, axes of P, QRS, and T waves are abnormal and the Nuss operation normalizes them. We also took the Haller index (HI) into to account. Methods: 17 PEX patients (14 male, 12±6 years) underwent CT and ECG before and after the Nuss operation. Results: All Nuss operations were successful, and HI was significantly improved from 5.62±2.29 to 3.29±0.65 (P=0.0002). There were no significant differences before and after surgery for electrical axes of P waves (46±20 vs 65±55, P=0.20), and QRS waves (75±33 vs 76±23, P=0.72), but T waves were greater thereafter (22±27 vs 40±19, P=0.001). Correlation coefficients (CC) between the degree of axes of P, QRS and T waves, and HI before operation were -0.23, -0.06, and 0.11, respectively. These values after operation were -0.25, -0.06, and 0.19, respectively. As HI is an indirect indicator of heart compression, we evaluated the degree of RA and LA compression qualitatively as none, mild, and moderate/more. Of 17 patients, 5 had moderate/more compression of RA and/or LA by PEX (group 1); the remaining 12 did not show compression (group 2). Only P wave values were significantly smaller in group 1 than 2 before surgery, but these differences disappeared after surgery. In both groups, degree of axes of T waves was significantly greater after the operation. Conclusion: In patients with PEX, axes of T waves after the Nuss operation became significant greater than before the operation in patients with moderate or more compression of RA and/or LA by PEX. For P waves, this was smaller before the operation in those with compression but this was improved by the Nuss operation. P and T wave axes but not QRS could be therefore non-invasive indicators of Nuss operation success in addition to gross PEX appearance.

P3448Influence of severity of pectus excavatum as indicated by the Haller Index on actual heart compression and ECG findings

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
N Funabashi ◽  
T Horikoshi ◽  
K Ozawa ◽  
Y Kobayashi
Keyword(s):  
Pectus Excavatum ◽  
Observer Agreement ◽  
P Wave ◽  
Axis Deviation ◽  
Sinus Arrhythmia ◽  
Dominant Type ◽  
Haller Index ◽  
Unenhanced Ct ◽  
Significant Difference ◽  
The Mean

Abstract Background Pectus excavatum (PEX) is a depression of the sternum relative to the costal cartilages. The Haller index (HI) is an anatomical indicator of the severity of PEX that is calculated from CT. Purpose We evaluated the influence of anatomical severity of PEX as indicated by HI on the severity of actual heart compression and ECG findings Methods A total of 28 patients (23 males; 20±19 years) with PEX underwent unenhanced CT and ECG. On CT, HI and degree of compression of right (RA) and left atria (LA) were evaluated simultaneously. Results As indicated by CT, the mean HI was 5.80±2.34. We observed 7, 15, 5, and 1 patient with none, mild, moderate, or severe RA compression, respectively. In addition, we observed 8, 13, 4, and 3 patients with none, mild, moderate, or severe LA compressions, respectively. The mean HI was calculated as 4.28±0.92, 5.40±2.01, 6.85±1.81, and 9.61±0.00 in patients with none, mild, moderate, or severe RA, respectively, and the findings were significant (P=0.021). The mean HI was calculated as 4.17±0.91, 5.97±2.23, 5.95±1.51, and 6.69±2.93 in patients with none, mild, moderate, or severe LA compression, respectively, although the findings were not significant (P=0.145). On ECG, a P wave with a negative portion >1 mm in depth and >40 ms in duration in the V1 lead, complete or incomplete right bundle branch block (RBBB), sinus arrhythmia, or right-axis deviation of a QRS wave were diagnosed in 23, 10, 8, and 6 patients, respectively. The HI between patients with (n=23) and without (n=5) a negative portion of the P wave in the V1 lead showed a significant difference (6.45±2.43 vs. 4.62±1.68; P<0.05). The correlation coefficient between absolute values of the maximum negative portion of the P wave in the V1 lead and HI was 0.36 (n=28). The HI between patients with and without a complete or incomplete RBBB showed a significant difference (6.98±2.43 vs. 5.14±2.07; P<0.05). The HI between patients with and without a sinus arrhythmia did not show a significant difference (5.45±2.66 vs. 5.94±2.25). The HI between patients with and without a right axis deviation on a QRS wave also did not show a significant difference (4.76±1.53 vs. 6.08±2.64). The inter-observer agreement of HI between the two observers was 0.978. Haller index and heart compression on CT Conclusion In patients with PEX, compression of RA on CT, a negative portion of the P wave in V1, complete or incomplete RBBB, sinus arrhythmia, and a right axis deviation on a QRS wave are common. The degree of compression of RA on CT, negative portion of the P wave in the V1 lead and complete or incomplete RBBB on ECG are associated with anatomical severity as indicated by the HI. However, our results showed that HI severity was unrelated to either the degree of compression of LA on CT, or sinus arrhythmia and right-axis deviation of the QRS wave on ECG. These observations may be due to variation of location of maximum sternum depression, such as high- or low-positioned dominant-type compressions.

Development and Properties of a New Correction Instrument of Pectus Excavatum

2009 ◽  
Vol 610-613 ◽  
pp. 1327-1330
Author(s):  
Yu Ling Hu ◽  
Xue Bao Yu ◽  
Wei Dong Miao ◽  
Gang Liu
Keyword(s):  
Mechanical Properties ◽  
Minimally Invasive ◽  
Pectus Excavatum ◽  
Testing Machine ◽  
Pure Titanium ◽  
Material Testing ◽  
Invasive Technique ◽  
Nuss Procedure ◽  
Universal Material Testing Machine ◽  
Material Testing Machine

A new correction instrument of pectus excavatum is introduced which is designed for a minimally invasive technique (Nuss procedure). The instrument was made of pure titanium plates, and finished by machining, surface treatment and so on. The instrument was made up of correcting bar and fixing bar. The mechanical properties of the instrument was measured with electron universal material testing machine, the safety and validity was verified by clinical doctors after being implanted into the patient. Results showed that the mechanical properties of the instrument keep constantly after implantation for two years. It is lighter than the like product, and can lighten the patent’s and the doctor’s operation bearing. It had been applied in national hospitals, and results showed that it was of better biocompatibility, and few complications were found. Clinical treatment effects were satisfactory.

scholarly journals Internal Mammary Artery Compression After Pectus Excavatum Repair Does Not Increase Risk of Hemorrhagic Complications in Pediatric Patients

2021 ◽  
Vol 8 ◽  
Author(s):  
Tamás Kovács ◽  
Gyula Pásztor ◽  
Anna Rieth
Keyword(s):  
Pectus Excavatum ◽  
Internal Mammary Artery ◽  
Study Data ◽  
Minimal Invasive ◽  
Nuss Procedure ◽  
Vascular Changes ◽  
Mammary Arteries ◽  
Hemorrhagic Complications ◽  
Increase Risk ◽  
Internal Mammary

Objectives: Minimal invasive repair of pectus excavatum (MIRPE) described by Nuss is the most popular correction nowadays of this deformity. During the introduction of the bars, they can hurt or compress the internal mammary arteries (IMA). The aim of this study was to observe the prevalence of IMA compression in children after MIRPE. Also, we examined if IMA obstruction increases the risk of complications at bar removal, and if these vascular changes are reversible.Materials and Methods: All patients operated on pectus excavatum in our tertiary pediatric surgical center between 2013 and 2019 were involved in the study. Data of age, sex, number of bars and characteristics of the deformity were examined. IMA flow was checked by Doppler ultrasound (DUS) after MIRPE and after bar removal, too.Results: Among 41 patients with mean age of 15.2 years there were 18 asymmetrical deformities, 23 sternal rotations. Mean pectus index was 4.01. After the Nuss procedure 7(9%) stenoses and 10(12%) occlusions of IMA were found on DUS. After bar removal 3 of 4 stenoses have resolved, but all examined occlusions (3/3) persisted. There were no complications during bar removals.Conclusion: IMA compression after MIRPE in children is uncommon, and is not influenced by severity of deformity. Obstruction of these vessels does not increase the risk of hemorrhagic complications at bar removal. Data of larger cohort are needed to determine reversibility of these changes.

Variations in Nuss Procedure Operative Techniques and Complications: A Retrospective Review

2021 ◽  
Author(s):  
Centura R. Anbarasu ◽  
Steven C. Mehl ◽  
Raphael C. Sun ◽  
Jorge I. Portuondo ◽  
Andres F. Espinoza ◽  
...  
Keyword(s):  
Retrospective Review ◽  
Pectus Excavatum ◽  
Statistical Significance ◽  
Intercostal Nerve ◽  
Nuss Procedure ◽  
Operative Techniques ◽  
Chi Square ◽  
Patient Demographics ◽  
Haller Index ◽  
Increased Risk

Abstract Introduction The Nuss procedure is the most common and preferred operative correction of pectus excavatum. Surgeon preference and patient factors can result in variations in Nuss procedure technique. We hypothesize that certain techniques are associated with increased risk of complications. Materials and Methods We performed a single-center retrospective review of Nuss operations from 2016 to 2020. Variations in intraoperative techniques included sternal elevator (SE) use, number of bars placed, and usage of bilateral stabilizing sutures. Patient demographics, intraoperative data, and postoperative outcomes were reported as median with interquartile ranges or percentages. Statistical significance (p < 0.05) was determined with Wilcoxon's rank-sum and chi-square tests. Multivariate analysis was performed to control for introduction of intercostal nerve cryoablation and surgeon volume, and reported as odds ratio with 95% confidence interval. Results Two hundred and sixty-five patients were identified. Patients repaired with two bars were older with a larger Haller index (HI). Patient demographics were not significantly different for SE or stabilizing suture use. Placement of two bars was associated with significantly increased risk of readmission. Similarly, SE use was associated with increased risk of pleural effusion and readmission. Finally, the use of bilateral stabilizing sutures resulted in less frequent slipped bars without statistical significance. Conclusion Older patients with a larger HI were more likely to need two bars placed to repair pectus excavatum. Placement of multiple bars and SE use are associated with significantly higher odds of certain complications.

scholarly journals Radiological changes after Nuss operation for pectus excavatum

Medicina ◽  
2009 ◽  
Vol 45 (9) ◽  
pp. 699 ◽  
Author(s):  
Artūras Kilda ◽  
Saulius Lukoševičius ◽  
Vidmantas Barauskas ◽  
Živilė Jankauskaitė ◽  
Algidas Basevičius
Keyword(s):  
Chest Wall ◽  
Pectus Excavatum ◽  
First Year ◽  
Nuss Procedure ◽  
Funnel Chest ◽  
Haller Index ◽  
Wall Deformation ◽  
Lateral Chest ◽  
Radiological Changes ◽  
The Mean

The objective of this study was to evaluate sternovertebral distance and the chest wall deformation after Nuss procedure. Materials and methods. Anteroposterior and lateral chest radiographs were performed before Nuss procedure, 1, 6, and 12 months after operation and finally 1 month after bar removal. Sternovertebral distance and transversal chest dimension were measured on radiographs, as well as Haller and vertebral indexes were calculated. Results. A total of 84 children with funnel chest were operated on. Preoperative sternovertebral distance was 79.81±6.96 mm; 1 month after operation, 97.84±17.08 mm; 6 months, 110.55±13.85 mm; and 12 months, 113.6±14.61 mm. After removal of the bar, the distance was 105±11.95 mm. The mean increase in sternovertebral distance during the first month was 18 mm (P<0.0001); 1–6 months, 12.8 mm (P=0.0006); and 6-12 months, 3 mm (P=0.48). The mean decrease in sternovertebral distance after removal of the bar was 8.6 mm (P=0.47). The decrease in transversal chest dimension during the first month was significant (13.3±12.86 mm, P=0.012). Conclusions. The sternovertebral distance was significantly increased after Nuss operation. Restoration of deformation proceeds during all the first year after operation. The dynamics of deformation is better depicted by means of vertebral index rather than Haller index.

Impact of pectus excavatum on pulmonary function before and after repair with the Nuss procedure

2005 ◽  
Vol 40 (1) ◽  
pp. 174-180 ◽  
Author(s):  
M. Louise Lawson ◽  
Robert B. Mellins ◽  
Meredith Tabangin ◽  
Robert E. Kelly ◽  
Daniel P. Croitoru ◽  
...  
Keyword(s):  
Pulmonary Function ◽  
Pectus Excavatum ◽  
Nuss Procedure ◽  
Before And After

scholarly journals Electrocardiographic patterns of Mangalarga Marchador horses before and after implementation of the marcha gait

2016 ◽  
Vol 46 (5) ◽  
pp. 915-920 ◽  
Author(s):  
Clarisse Simões Coelho ◽  
Gabriella Agra de Omena e Silva ◽  
Luiz Antonio Trindade Oliveira Junior ◽  
Vanessa Sartor Moraes ◽  
Laura Monteiro de Castro Conti ◽  
...  
Keyword(s):  
Qt Interval ◽  
P Wave ◽  
Qrs Complex ◽  
Sinus Arrhythmia ◽  
Qt Intervals ◽  
Pr Interval ◽  
Before And After ◽  
Kolmogorov Smirnov ◽  
Electrocardiographic Parameters ◽  
T Waves

ABSTRACT: The aim of this study was to evaluate the electrocardiographic parameters in Mangalarga Marchador horses submitted to marcha exercise. Twenty-four Mangalarga Marchador horses, thirteen females and eleven males, 6.4±2.7 years old with a mean weight of 428.3±24.7kg, were used. Electrocardiograms were recorded in two different moments: rest and immediately after exercise (40 minutes of aerobic exercise, marcha gait). The electrocardiographic variables analyzed were cardiac rhythm, heart rate (HR), duration of P wave, QRS complex, PR and QT intervals, amplitudes of P, R and T waves, and analysis of QT corrected (QTc) according to Bazett's formula (QT/√RR). Variables were analyzed for normality with Kolmogorov-Smirnov test and paired t-test, considering P<0.05. Rhythm analysis revealed 91.7% of sinus rhythm and 8.3% of sinus arrhythmia in rest, with mean HR of 45.7±12.7 beats minute-1, and 100% of sinus tachycardia, with mean HR of 77.3±13.5 beats minute-1 after exercise (P<0.0001). In post-exercise, it was possible to observe decreases in P wave duration (P=0.0121), PR interval (P=0.0007) and QT interval (P<0.0001) and increase of QTc (P=0.0039) and R wave amplitude (P=0.0033). There were no significant differences for amplitude of P and T waves and QRS complex related to atrioventricular enlargement. Although QT interval decreased after exercise, there was an increase on QTc after exercise, indicating changes in ventricular repolarization. It was possible to conclude that the imposed exercise (marcha gait) led to electrocardiographic alterations without causing pathological arrhythmias.

scholarly journals Finding suitable candidates for vacuum bell therapy in pectus excavatum patients

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Eunjue Yi ◽  
Kwanghyoung Lee ◽  
Younggi Jung ◽  
Jae Ho Chung ◽  
Han Sung Kim ◽  
...  
Keyword(s):  
Pectus Excavatum ◽  
Expected Improvement ◽  
Treatment Results ◽  
Chest Computed Tomography ◽  
Haller Index ◽  
Before And After ◽  
Treatment Changes ◽  
Pre Treatment ◽  
Group 2 ◽  
Group 1

AbstractVacuum bell therapy has been acceptable substitute for pectus excavatum patients who want to improve their appearance but avoid surgical correction. The aim of this study was to assess the pre-treatment characteristics of patients with pectus excavatum and to establish characteristics that can potentially help identify ideal candidates for vacuum bell therapy. Expected improvements in thoracic indices were evaluated using pre-treatment chest computed tomography, which was performed before and after applying a vacuum bell device. Treatment results after 1-year of application were evaluated using changes in the Haller index before and after treatment. The patients were categorized into two groups according the post- treatment changes in Haller index calculated using chest radiographs: those with changes in Haller index less than 0.5 (Group 1) and those with greater than or equal to 0.5 (Group 2). Pre-treatment Haller index was significantly lower in Group 1 than in Group 2 (3.1 ± 0.46 vs. 4.2 ± 1.14, respectively, p < 0.001). The expected improvement in Haller index in Group 2 was significantly higher than that in Group 1 (3.3 ± 0.60 vs. 2.8 ± 0.54, respectively, p = 0.001). The cut-off value of the expected improvement in Haller index was 0.46 with a sensitivity of 75.8% and a specificity of 83.3%. Patients who demonstrated pliability with a vacuum bell were identified as suitable candidates.

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