Implementation and acceptance rates of a specially designed vacuometer for the vacuum bell treatment of pectus excavatum.

BACKGROUND / PURPOSE: To report the implementation of a specially designed vacuometer for the ambulatory measurement of the exact negative pressure self-applied by the patient when using the vacuum bell for the treatment of pectus excavatum and to analyze patient satisfaction with the device, by conducting a survey. METHODS: Between October 2018 and June 2020, all patients with pectus excavatum who received a vacuum bell at our Pectus Clinic were provided with a specially designed pectus vacuometer for their personal use. We described the vacuometer, the fundamentals of its development, and the utilization protocol. A survey was conducted evaluating comfort, clarity of instructions, usefulness, simplicity of connection, and likeability. The level of satisfaction was assessed using a Likert scale ranging from 1 (very negative experience) to 5 (very positive experience). The occurrence of skin lesions provoked by the application of the vacuum bell was registered. RESULTS: From 72 submitted surveys, 54 patients answered. Patient demographics comprised 44 (81.5%) males and a mean age of 12.6 ± 6.0 years. The mean initial external pectus depth was 2.0 ± 0.7 cm and the mean duration of treatment was 13.2 ± 8.6 months. No skin lesions were detected while using the vacuum bell and the vacuometer. The mean general satisfaction score was 4.4 ± 0.7 and 83.3% of the respondents did not have any inconvenience with the vacuometer. A patient who considered himself cured was the only dropout during the study. CONCLUSIONS: In this study, we described the feasibility and fundamentals of the application of a specifically designed vacuometer for ambulatory use as an adjunct to the treatment of pectus excavatum with a vacuum bell, and demonstrated a high satisfaction level with the device. In addition, the vacuometer might help avoid skin lesions secondary to the vacuum bell and foster adhesion to treatment. TYPE OF STUDY: Treatment study. LEVEL OF EVIDENCE: IV.

Sternal torsion in pectus excavatum is related to cardiac compression and chest malformation indexes.

BACKGROUND/PURPOSE: The role of sternal torsion (ST) in patients with pectus excavatum (PEX) is unknown. We evaluated the relationship between ST and both chest malformation and cardiac compression (CC) indexes. METHODS: We included consecutive patients with PEX who underwent chest computed tomography and cardiac magnetic resonance (CMR) to define surgical candidacy. Malformation indexes included the Haller index (HI), correction index (CI), and ST. CC and the tricuspid to mitral annulus width ratio were evaluated using CMR. RESULTS: One-hundred and sixteen patients were included, with a mean HI of 5.8 ±â€¯3.6 and a mean CI of 35.8 ±â€¯18.0%. ST was significantly related to malformation indexes, being patients with absence of ST those showing the lowest HI (p = 0.048) and CI (p = 0.002). Right-sided ST was significantly related to the CC classification (p = 0.0001), and the tricuspid/mitral annulus width ratio was significantly lower among these patients (absence 0.98 ±â€¯0.15, left-sided 0.91 ±â€¯0.10, right-sided 0.80 ±â€¯0.15, p < 0.0001). A significant inverse relationship between ST degrees and the tricuspid/mitral ratio was also identified (r = -0.47, p < 0.0001). CONCLUSIONS: We identified a significant relationship between ST and both chest malformation and CC indexes; the absence of ST being identified as a marker of an overall more benign phenotype. TYPE OF STUDY: Study of diagnostic test. LEVEL OF EVIDENCE: Level II.

Impact of pectus excavatum on cardiac morphology and function according to the site of maximum compression: effect of physical exertion and respiratory cycle.

AIMS: Previous studies have demonstrated diverse cardiac manifestations in patients with pectus excavatum (PEX), although mostly addressing morphological or physiological impact as separate findings. Using multimodality imaging, we evaluated the impact of PEX on cardiac morphology and function according to the site of maximum compression, and the effect of exertion and breathing. METHODS AND RESULTS: All patients underwent chest computed tomography, cardiac magnetic resonance (CMR), and stress echocardiography (echo) in order to establish surgical candidacy. We evaluated diastolic function and trans-tricuspid gradient during stress (echo); and systolic function and respiratory-related septal wall motion abnormalities (CMR). Patients were classified according to the site of cardiac compression as type 0 (without cardiac compression); type 1 (right ventricle); and type 2 [right ventricle and atrioventricular (AV) groove]. Fifty-nine patients underwent multimodality imaging, with a mean age of 19.5 ± 5.9 years. Compared with a sex and age matched control group, peak exercise capacity was lower in patients with PEX (8.4 ± 2.0 METs vs. 15.1 ± 4.6 METs, P < 0.0001). At stress, significant differences were found between groups regarding left ventricular E/A (P = 0.004) and e/a ratio (P = 0.005), right ventricular E/A ratio (P = 0.03), and trans-tricuspid gradient (P = 0.001). At CMR, only 9 (15%) patients with PEX had normal septal motion, whereas 17 (29%) had septal flattening during inspiration. Septal motion abnormalities were significantly related to the cardiac compression classification (P < 0.0001). CONCLUSIONS: The present study demonstrated that patients with PEX, particularly those with compression affecting the right ventricle and AV groove, manifest diverse cardiac abnormalities that are mostly related to exertion, inspiration, and diastolic function.