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At least 667 records · Page 37Linked to original sources
PubMed1988

[Deformity of the cardiac structures in patients with mitral valve prolapse: the relationship with flat chest].

In view of the close relationship of mitral valve prolapse (MVP) and chest deformity, seven patients of MVP associated with flat chest were echocardiographically evaluated, and the results were compared with those of 43 normal control subjects, 29 cases with flat chest, and patients with MVP either of the anterior (25 cases) or posterior (21 cases) leaflet. MVP associated with flat chest was observed in the anterior leaflet in all cases. MVP was related to the dislocation of the two mitral leaflets caused by the displaced posterior mitral ring observed by two-dimensional echocardiography. The transition type was observed among the cases with or without dislocation of the mitral ring in cases with flat chest.

Adolescent↗
PubMed2006

[Cine MRI of the thorax in patients with pectus excavatum].

BACKGROUND: Morphologic and dynamic assessment of respiratory chest kinetics was performed in patients with pectus excavatum deformity (PE) using dynamic MRI: cine MRI. MATERIAL AND METHODS: Seven consecutive patients with PE (aged 20.3 years+/-4.0) and ten healthy volunteers of comparable age underwent real-time cine MRI of the chest during breathing on a 1.5 T MR scanner (Magnetom Sonata, Siemens Medical Systems, Erlangen, Germany) using a standard phased array body coil and a half-Fourier single-shot turbo spin echo sequence (HASTE) for dynamic imaging. During deep inspiration and expiration, single-shot sequences were performed in one slice level over 20 s at a frequency of 1 image/s covering the entire thoracic cage in three orientations. Morphology and chest kinetics in patients with PE were analyzed and compared with normal values, and typical patterns of chest kinetics were noted. RESULTS: Three different types of chest morphology in PE were identified: (1) the generally flattened thoracic cage, (2) the "tilted" sternum, and (3) the focally deepened sternum. Three patterns of motion correspond to these morphological types: (1) elevation of the sternum and the anterior thoracic wall, (2) angulated elevation of the parasternal rib cage with persistent deepening of the sternum resembling a "wing beat" movement, and (3) increased diaphragmatic movements with limited chest wall dynamics. CONCLUSIONS: Cine MRI is an adequate radiation-free diagnostic modality for the dynamic imaging of both chest morphology and chest wall kinetics in patients with PE. The pectus severity index can easily be determined and three typical movement patterns of chest wall kinetics identified.

Adolescent↗
PubMed2004

Age-related normal ranges for the Haller index in children.

PURPOSE: The Haller index is an accepted CT method for evaluating thoracic dimensions in patients with pectus excavatum. The purpose of this study is to establish age- and gender-related norms for the Haller index in childhood. MATERIALS AND METHODS: We retrospectively reviewed 574 consecutive chest CT examinations (M=285, F=289) performed at our institution from August 2001 through March 2002. Seventeen patients with a history of chest-wall deformity, trauma, or syndrome were excluded, for a total sample size of 557 patients. The Haller index was calculated for each patient, using electronic calipers. The sample population was then separated by gender and placed into 2-year age groupings. Two-way analysis of variance and Tukey's multiple comparisons were performed to determine significance at a=0.05. The least-square mean Haller index values for each age group and gender were calculated with 95% confidence intervals. RESULTS: In both males and females, the 0- to 2-year age group showed a significantly smaller mean Haller index than older children. In addition, females had significantly greater Haller index values than males in the 0- to 6- and 12- to 18-year age groups. CONCLUSION: The Haller index, a quantitative measurement of chest-wall configuration, demonstrates significant age- and gender-related variability. This should be considered when evaluating the patient with suspected chest-wall deformity.

Adolescent↗
PubMed1994

Bioabsorbable struts made from poly-L-lactide and their application for treatment of chest deformity.

Poly-L-lactide, a polymer of lactic acid, shows slow degradation in living tissue. Poly-L-lactide plate of high molecular weight maintains more than 90% of its initial mechanical properties for more than 3 months after implantation. Using struts made from poly-L-lactide plate, we performed chest wall reconstruction in 56 patients: for postoperative chronic sternal dehiscence in 23 and sternal elevation for pectus excavatum in 33 cases. The postoperative external appearances of the anterior chest were improved in comparison with the preoperative state in all cases. The internal features were evaluated by computed tomographic scan. Neither postoperative wound infection nor respiratory complication was observed, and no tendency for regression of the anterior chest occurred in any of the patients. In 3 of 56 cases (5.4%; one in the sternal dehiscence group and two in the pectus excavatum group), it was necessary to remove part of the strut because of overgrowth of granulation tissue around the implanted material after 4, 12, and 13 postoperative months, respectively. In the pectus excavatum group, the computed tomographic evaluations showed that poly-L-lactide strut maintained sufficient strength to support the thoracic wall 5 months after implantation. These findings suggest that the bioabsorbable poly-L-lactide strut is a promising material for surgical treatment of chest deformity.

Absorption↗
PubMed1995

Casting the implant for reconstruction of pectus excavatum.

Fourteen patients with pectus excavatum underwent a total of 17 operations for the insertion of subcutaneous implants aimed at camouflaging their defects. A silicone prosthesis in one patient early in the series caused severe capsular formation. Although a block of Proplast may occasionally be used with success, the rational solution to the problem is to produce a custom made Silastic implant that adheres optimally to the defect in each individual case. This retrospective study shows that a subcutaneous implant clearly improves the appearance of the chest wall in most of the patients.

Adolescent↗
PubMed1981

Pectus excavatum from chronic upper airway obstruction.

Two patient with enlarged adenoids and tonsils had cardiopulmonary distress and pectus excavatum. In both patients, the cardiorespiratory difficulty and the pectus deformity were relieved by removing the obstructive adenoids and tonsils. This observation supports the hypothesis that upper airway obstruction can cause a chest wall deformity. In a patient with cardiorespiratory distress and pectus excavatum, upper airway obstruction should be considered.

Adenoidectomy↗
PubMed1995

Relation of right ventricular morphology and function in pectus excavatum to the severity of the chest wall deformity.

Although pectus excavatum (PE) is thought to impair right ventricular (RV) performance, the degree of RV dysfunction, if any, produced by this chest wall deformity remains controversial. To address this issue, we performed 2-dimensional echocardiography and chest wall radiography in 28 subjects with mild-to-severe degrees of PE to assess RV morphology and function in relation to the degree of the chest wall deformity. Measurements of RV anatomy and function obtained in these patients were compared to those of 24 normal control subjects of similar age and sex. In subjects with PE, mean RV outflow tract diameter at the aortic root level was narrower (1.4 +/- 0.3 cm/m2) and end-diastolic (10 +/- 2.3 cm2/m2) and end-systolic (5.8 +/- 1.4 cm2/m2) areas were larger than those in normal controls (1.6 +/- 0.3, 8.6 +/- 1.7, and 4.5 +/- 1.2 cm2/m2, respectively; p < 0.013). The magnitude of these abnormalities was related to the degree of the chest wall deformity evaluated on the chest radiogram (r = 0.54, 0.51, and 0.49, respectively). RV planar emptying fraction, an index of RV systolic function, was reduced in subjects with PE (42 +/- 10%) compared to the normal controls (48 +/- 10%; p = 0.047). No relation could be found, however, between this index and the severity of the chest wall deformity.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed2001

Breath-hold MRI in evaluating patients with pectus excavatum.

Pectus excavatum (PE) is a congenital condition in which the sternum is displaced posteriorly with associated changes in the adjacent costal cartilages. The aetiology of PE is uncertain although various underlying abnormalities of the diaphragm have been implicated. There is sparse information regarding the use of fast MRI in evaluating the deformity. Our aims were to use fast MRI to evaluate static and respiratory-related dynamic chest wall characteristics, the extent of cardiac displacement and diaphragmatic excursion in patients. FLASH and TurboFLASH MR sequences in axial and coronal planes were performed on the thoraces of six young patients with PE and six individually matched healthy controls during full inspiratory and full expiratory breath-holds. The Pectus Index was derived from chest wall measurements using axial images. The distances of the left and right cardiac borders from the midline were measured using axial images, and excursion of the dome of each hemidiaphragm was measured using coronal images. The degree of sternal depression worsened substantially in expiration. Anterior chest wall movement was similar in the two groups. Patients had significantly flatter chests than the controls. There was a trend towards leftward cardiac displacement in the patients (maximum distance between left heart border and midline during full expiration 99.5 mm in patients and 91.8 mm in controls). The right diaphragmatic dome excursion was greater than the left in the controls (53.6 mm and 47.4 mm, respectively), but this was not seen in the patients (50.2 mm and 50.4 mm, respectively). It is concluded that fast MRI is very informative in evaluating skeletal abnormalities, chest wall motion, and cardiac and diaphragmatic changes seen in PE.

Adolescent↗
PubMed2004

Cardiac tamponade presenting to the emergency department after sternal wire disruption.

An unusual case of cardiac tamponade presenting to the emergency department is reported in a patient with sternal wire disruption after a pectus excavatum repair two years previously. The complication, although rare may have potentially life threatening sequelae and therefore consideration of sternal wire disruption in all patients presenting with chest pain after a previous sternotomy should be made.

Adult↗
PubMed2005

[Radiologic and clinical aspects of developmental anomalies of the chest wall].

The radiological and clinical presentations of developmental anomalies of anterior chest wall are reported. The authors describe the main diagnostic and therapeutic issues including corrective surgery, its complications and progress in diagnostic imagining. The methods and parameters used in the assessment of the degree of chest wall deformity in patients with pectus excavatum (PE) and pectus carinatum (PC) are also discussed.

Funnel Chest↗
PubMed1985

Children with Marfan's syndrome and pectus excavatum.

Pectus excavatum occurs in two thirds of children with Marfan's syndrome. The characteristics of seven children with Marfan's syndrome and pectus excavatum were compared with those of 38 children who had pectus excavatum without Marfan's syndrome. The children with Marfan's syndrome presented later, had progressive defects, and were more likely to have wound problems; however, acceptable cosmetic and functional results after chest wall repair were obtained in the patients with Marfan's syndrome.

Adolescent↗
PubMed1992

[Long-term outcome of pectus excavatum surgically treated in children].

The authors have studied the result of 34 pectus excavatum, corrected by two surgical methods, followed up between 3 and 20 years: half of cases were treated by Judet's procedure, making turn over of anterior wall chest, with 35 per cent of good result. The other cases were treated by sternochondroplasty and internal fixation, with 88 per cent of good result. Early failures related to sternal non union and to infection, occurred in 53 per cent of Judet's procedure; eight of the 13 failures were managed by sternochondroplasty (7 cases) and Judet's procedure (1 case); followed by good results. Failure at further time was related to the young age of the patients at treatment, to the deficiency of fixation and early removal of material. Consequently, durable correction at long term was obtained, when treatment was performed by sternochondroplasty procedure, over 14 years of age, when many pins were used for fixing the correction, left in place for more than one year. In such cases, we didn't observe regression of result. When small residual deformities subsisted they were often masked by the development of the muscles in man, and breast in woman, providing acceptable aspect of chest.

Adolescent↗
PubMed1984

Some telltales and pitfalls in chest radiology.

The chest radiograph may contain a wealth of information concerning the patient's condition and habits. Moreover, looking at the neck and chest wall and below the diaphragm is an integral part of reading the chest radiograph. A few pitfalls are also described in this article.

Adolescent↗
PubMed2004

Open repair of pectus excavatum with minimal cartilage resection.

OBJECTIVE: To summarize the clinical experience with a new open repair for pectus excavatum (PE), with minimal cartilage resection. SUMMARY BACKGROUND DATA: A wide variety of modified techniques of the Ravitch repair for PE have been used over the past 5 decades, with the complications and results being inconsistent. Extensive subperiosteal costal cartilage resection and perichondrial sheath detachment from the sternum may not be necessary for optimal repair. METHODS: During a 12-month period, 75 consecutive patients with symptomatic PE underwent open repair using a new less invasive technique. After exposing the deformed costal cartilages, a short chip was resected medially adjacent to the sternum and laterally at the level where the chest had a near normal contour, allowing the cartilage to be elevated to the desired level with minimal force. A transverse anterior sternal osteotomy was used on most patients. A substernal support strut was used for 66 patients; the strut was placed anterior to the sternum in 9 patients under age 12 and over age 40 years. The strut was routinely removed within 6 months. RESULTS: With a mean follow-up of 8.2 months, all but 1 patient regarded the results as very good or excellent. Mean operating time was 174 minutes; mean hospitalization was 2.7 days. There were no major complications or deaths. CONCLUSIONS: The open repair using minimal cartilage resection is effective for all variations of PE in patients of all ages, uses short operating time, provides a stable early postoperative chest wall, causes only mild postoperative pain, and produces good physiologic and cosmetic results.

Adolescent↗