A novel video-assisted thoracoscopic approach for pectus excavatum surgical treatment in a dog.

OBJECTIVE: To describe a novel, video-assisted thoracoscopic surgery (VATS) approach used to treat pectus excavatum (PE) in a dog. ANIMALS: A 5 month-old, 5.1 kg, intact, female, Cockapoo. STUDY DESIGN: Case report. METHODS: Clinical, imaging and surgical records of a dog with severe PE who underwent VATS-assisted sternal cast placement were reviewed and reported. Treatment involved introduction of a mild pneumothorax and use of VATS, allowing direct visualization and therefore safe passage of circumsternal sutures as they were placed to reduce the risk of vascular/cardiac or pulmonary penetration and intraoperative complication in this patient. RESULTS: Treatment involved introduction of a mild pneumothorax and use of VATS, allowing direct visualization and therefore safe passage of circumsternal sutures as they were placed to reduce the risk of vascular/cardiac or pulmonary penetration and intraoperative complications in this patient. The patient recovered well and had an excellent long-term outcome with significantly improved vertebral index and frontosagittal index. CONCLUSION: This modified technique resulted in an excellent outcome and minimized the risk of intraoperative complications during the surgical procedure in a dog. CLINICAL SIGNIFICANCE: This novel VATS approach for PE correction may provide a useful technique to help reduce intraoperative risk during PE correction in dogs.

Pectus excavatum ­ Correção cirúrgica utilizando tala externa de poliuretano fabricada com tecnologia de impressão 3D / Pectus excavatum ­ Surgical correction, using polyurethane external splint made with 3D printing technology

Objetivou-se relatar o emprego de uma tala externa confeccionada com material de poliuretano e cobertura interna de neopreme na reparação cirúrgica do pectus excavatum em um felino jovem. O felino apresentava deformidade anatômica congênita na região do externo e sinais clínicos respiratórios. Imagens avançadas de tomografia foram utilizadas para moldar a tala impressa com tecnologia tridimensional. Esta alternativa possibilitou melhor planejamento cirúrgico e, com isso, conforto para o paciente, além da qualidade própria do material de poliuretano que é levemente maleável, o que permitiu melhor moldagem e expansão torácica durante a respiração. A tala se provou resistente o suficiente para suportar a tração ocasionada pelos fios de sutura e possibilitou o reposicionamento adequado do osso esterno ao mesmo tempo que se mostrou confortável e acarretou mínimas lesões ao paciente.

The aim of this paper was to report the use of an external splint made of polyurethane material and internal neopreme covering in the surgical repair of a pectus excavatum in a young feline. The feline exhibited a congenital anatomical deformity in the external region and clinical respiratory signs. Advanced CT images were used to shape the 3D-printed splint. This alternative allowed better surgical planning and, therefore, comfort for the patient, this because to the quality of the polyurethane material, which is slightly malleable, and allowed for better molding and chest expansion during breathing. The splint proved to be strong enough to withstand the traction caused by the suture threads and allowed the proper repositioning of the sternum, at the same time it was comfortable and caused minimal injuries to the patient.

Use of a customized 3D-printed external splint for the correction of a severe pectus excavatum in a 3-month-old kitten.

Background: Pectus excavatum is a rare congenital or developmental deformity of the chest wall that has been reported in both dogs and cats. The clinical symptoms vary in severity and are correlated with the grade of the deformity. The most severe cases are at a very high risk of intra- and post-operative complications that could be fatal. Case Description: A 3-month-old kitten was presented for severe dyspnea and exercise intolerance. After the radiographic diagnosis of severe pectus excavatum, a splint was designed based on the computed tomography scan of the kitten. A locking mechanism was applied on a dedicated pocket on the splint and secured with commercial glue. Five sutures were placed, the most caudal three with a surgical approach to the corresponding sternebra. The three caudal traction sutures were progressively tensioned during the first 2 weeks, and then tied. The splint was removed 1 month postoperatively; neither surgical nor splint-associated complications were observed. The kitten well tolerated the splint and the owner reported no further episodes of dyspnea or exercise intolerance. Vertebral and frontosagittal indexes were 3.2 and 9.1 at presentation, respectively, and 10.2 and 2.0 at 4 months postoperatively. Conclusion: The use of a patient-specific 3D-printed external splint associated with a progressive correction of the pectus excavatum can be a better solution for the treatment of severe cases of pectus excavatum, where a sudden distension of the rib cage could cause re-expansion injuries.

Presumed acquired dynamic pectus excavatum in a cat.

An 11-year-old, spayed female American domestic shorthair cat was presented with open-mouth breathing and dyspnea due to respiratory tract disease. Radiographically, there was thickening of the retropharyngeal soft tissue and soft palate, focal pulmonary change, and severe pectus excavatum (PE), best seen on the left lateral view. Repeat thoracic radiographs 4 months later showed persistent PE, but only on the right lateral view; PE was absent on the left lateral view. The dynamic component of the observed PE was presumably acquired secondary to chronic upper respiratory disease and/or concurrent increased pliability of the thoracic wall from prolonged prednisolone treatment.

Pectus excavatum dynamique acquis présumé chez un chat. Une chatte domestique américaine stérilisée de 11 ans a présenté une respiration à bouche ouverte et une dyspnée due à une maladie des voies respiratoires. Radiographiquement, il y avait un épaississement des tissus mous rétropharyngés et du palais mou, une modification pulmonaire focale et un pectus excavatum (PE) sévère, mieux visible sur la vue latérale gauche. Des radiographies thoraciques répétées 4 mois plus tard ont montré une PE persistante, mais uniquement sur la vue latérale droite; la PE était absent sur la vue latérale gauche. La composante dynamique de la PE observée était vraisemblablement acquise secondaire à une maladie chronique des voies respiratoires supérieures et/ou à une flexibilité accrue concomitante de la paroi thoracique à la suite d'un traitement prolongé à la prednisolone.(Traduit par Dr Serge Messier).

Prevalence of pectus excavatum (PE), pectus carinatum (PC), tracheal hypoplasia, thoracic spine deformities and lateral heart displacement in thoracic radiographs of screw-tailed brachycephalic dogs.

Pectus excavatum, thoracic spine deformities, tracheal hypoplasia and lateral heart displacement are frequently described in brachycephalic dog breeds. Pectus carinatum is described sporadically, although the authors' observations demonstrate that it may occur in certain brachycephalic dog breeds. It was hypothesised that dogs of screw-tailed brachycephalic breeds carry a greater risk of these anomalies than normal-tailed brachycephalic breeds, and that there could a relation between the presence of pectus excavatum or pectus carinatum and thoracic spine deformities, tracheal hypoplasia and lateral heart displacement. During retrospective studies, these anomalies were identified in lateral and dorso-ventral radiographs of the thorax in brachycephalic dog breeds. A statistical analysis revealed that the frequency of pectus excavatum occurrence in screw-tailed and normal-tailed brachycephalic dog breeds is similar. The greatest risk of pectus excavatum occurrence is carried by two breeds: Maltese (60%) and English Bulldog (58%), while for pectus carinatum: Pug (41%) and French Bulldog (18%). Dogs of screw-tailed brachycephalic breeds carry a greater risk of kyphosis (p < 0.0001), tracheal hypoplasia occurrence (p < 0.0001), compared to "normal-tailed" breeds. The hypothesis concerning a relation between the presence of pectus excavatum or pectus carinatum and the other anomalies studied was not confirmed (p > 0.05). It was demonstrated that in dogs of brachycephalic breeds there was a greater risk of co-incidence between kyphosis of the thoracic spine and lateral heart displacement (p = 0.038), as well as kyphosis of the thoracic spine and tracheal hypoplasia (p = 0.003).

Pectus excavatum: computed tomography and medium-term surgical outcome in a prospective cohort of 10 kittens.

OBJECTIVES: The objective of this study was to report the use of computed tomography (CT) in conjunction with clinical signs to assess the severity of pectus excavatum (PE) in kittens and to guide surgical decision-making; also to report medium-term outcome in a prospective cohort of kittens undergoing surgical correction. METHODS: This was a prospective study of 10-15-week-old kittens (n = 10) diagnosed with moderate/severe PE. RESULTS: CT provides additional information that is useful for selecting patients for surgical correction and for planning the surgery. Traditional radiographic indices (vertebral, frontosagittal) provide reasonable approximations of the CT-determined dimensions but these seem to correlate poorly with the severity of clinical signs. Kittens commonly have lateralised deformities, which are associated with less severe clinical signs, while those with midline deformities are associated with more severe clinical signs. Six of seven kittens with severe PE that had a ventral splint applied for 4 weeks had excellent medium-term outcomes. CONCLUSIONS AND RELEVANCE: Restriction of diastolic filling by midline sternal deviation may be an important cause of exercise intolerance in cats with PE. CT can be used to assess affected kittens and to plan surgery when indicated.

Pectus excavatum in an English Bulldog male: a case report / Pectus excavatum en un Bulldog Inglés: reporte de caso / Pectus excavatum num Bulldog Inglés: registro de caso

El Pectus excavatum (PE) es una deformación de la caja torácica por crecimiento anómalo del esternón y costocartílagos que recae en una depresión condroesterna. Esta anormalidad anatómica (PE) se adquiere durante la vida intrauterina, y puede ser el resultado de expresiones genómicas heredables, acortamiento del tendón central del diafragma, anormalidades en la presión intrauterina y deficiencia congénita de la musculatura en la porción craneal del diafragma. En este caso se presenta un paciente Bulldog inglés macho de 30 días de edad con alteración en el sistema respiratorio, debilidad, adinamia, taquipnea, rinorrea blanquecina, con una marcada depresión del esternón y del arco costal, confirmando por estudio radiográfico de tórax y por necropsia la presencia de un PE. Con este reporte se pretende describir esta patología en un caso clínico y contribuir al conocimiento clínico de la enfermedad, ya que las descripciones publicadas de dicha enfermedad en nuestro país son escazas.

Pectus excavatum (PE) is a thoracic wall deformity due to an anomalous growth of sternum and costal cartilages wich relapse on a condroesternal depression. This anatomical abnormality gets acquired into the uterus, and may be the result of heritable genetic expressions, such as the shortening the central tendon of the diaphragm, abnormalities in the intrauterina pressure and congenital deficiency of the musculature in the cranial portion of the diaphragm. This report illustrates the case of a 30 days English bulldog male patient which suffer of alterations in the respiratory system, weakness, adynamia, tachypnea, whitish rhinorrhea, and which has a marked depression of the sternum and rib; the presence of PE was confirmed by chest X-ray and by necropsy. The purpose of this report is to describe this sickness in a particular case and contribute to clinical knowledge of PE, since published descriptions of this condition in our country are scarce.condition in our country are scarce.

O Pectus excavatum (PE) é uma deformação da caixa torácica por crescimento anormal do esterno e cartilagens que cai numa depressão condroesternal. Esta anormalidade anatômica (PE) é adquirida durante a vida intra-uterina, e pode ser o resultado de expressões genômicas herdáveis, encurtamento do tendão central do diafragma, anormalidades na pressão intra-uterina e deficiência congênita da musculatura na porção craniana do diafragma. Neste caso se apresenta um paciente Bulldog inglês macho de 30 dias de idade com alteração no sistema respiratório, fraqueza, adinamia, taquipnéia, rinorréia blanquecina, com uma marcada depressão do esterno e do arco costal, confirmando por estudo radiográfico de tórax e por necropsia a presença de um PE. Com este registro se pretende descrever esta patologia num caso clínico e contribuir ao conhecimento clínico da doença, já que as descrições publicadas dessa doença em nosso país são escassas.

Age-related thoracic radiographic changes in golden and labrador retriever muscular dystrophy.

Golden retriever and Labrador retriever muscular dystrophy are inherited progressive degenerative myopathies that are used as models of Duchenne muscular dystrophy in man. Thoracic lesions were reported to be the most consistent radiographic finding in golden retriever dogs in a study where radiographs were performed at a single-time point. Muscular dystrophy worsens clinically over time and longitudinal studies in dogs are lacking. Thus our goal was to describe the thoracic abnormalities of golden retriever and Labrador retriever dogs, to determine the timing of first expression and their evolution with time. To this purpose, we retrospectively reviewed 390 monthly radiographic studies of 38 golden retrievers and six Labrador retrievers with muscular dystrophy. The same thoracic lesions were found in both golden and Labrador retrievers. They included, in decreasing frequency, flattened and/or scalloped diaphragmatic shape (43/44), pulmonary hyperinflation (34/44), hiatal hernia (34/44), cranial pectus excavatum (23/44), bronchopneumonia (22/44), and megaesophagus (14/44). The last three lesions were not reported in a previous radiographic study in golden retriever dogs. In all but two dogs the thoracic changes were detected between 4 and 10 months and were persistent or worsened over time. Clinically, muscular dystrophy should be included in the differential diagnosis of dogs with a combination of these thoracic radiographic findings.

Open surgical correction combined with an external splint for correction of a non-compliant pectus excavatum in a cat.

A 4-month-old domestic shorthair female cat weighing 1.3 kg was presented for evaluation of respiratory distress. The animal showed evident dyspnoea with exercise intolerance and a marked concave deformation of the sternum. After measurements of the fronto-sagittal and vertebral indexes, the pectus was classified as moderate and surgery was elected. Surgical correction was performed using an open approach to the sternum with osteotomy of the last sternebra and costochondral junctions of the eighth and ninth ribs bilaterally. A silicone based, U-shape external splint was manufactured and used to stabilise the sternum. Immediate and 5-week postsurgical radiographs revealed a decreased concavity of the sternum and an increase thoracic height at the level of the last sternebra. Postoperative results suggest that this technique could be an effective and economical option for cats with pectus excavatum with a non-compliant sternum.

Increased incidence of thoracic wall deformities in related Bengal kittens.

Clinical records made during routine vaccinations were compared between populations of domestic shorthair cats and Bengal kittens. An increased incidence (12/244) of thoracic wall deformity was detected amongst the Bengal kittens. Deformities detected were: pectus excavatum (five), unilateral thoracic wall concavity (six) and scoliosis (one). Five-generation pedigrees were analysed for the affected kittens that showed a high degree of common ancestry indicating the likelihood of a familial cause.

Imaging diagnosis--acquired pectus excavatum secondary to laryngeal paralysis in a dog.

A 13-year-old neutered female Labrador retriever had inspiratory dyspnea secondary to bilateral laryngeal paralysis. Radiographically, there was pectus excavatum with a mediastinal shift to the right. Arytenoid lateralization was performed, relieving the upper respiratory obstruction, and the sternal deformity also resolved. Chronic upper respiratory obstruction should be considered in dogs with pectus excavatum. Furthermore, correction of upper respiratory obstruction has the potential to result in resolution of pectus excavatum.

External splinting for treatment of pectus excavatum in a dog with right ventricular outflow obstruction.

Right ventricular outflow tract obstruction was diagnosed by Doppler echocardiography in a young dog with a cardiac murmur, severe dyspnea, and a prominent sternal depression. Thoracic radiography confirmed a diagnosis of pectus excavatum involving the caudal third of the sternum. The right ventricular outflow obstruction was attributed to cardiac compression from the dorsally deviated sternum. External surgical splinting of the sternabrae, demonstrated by video in this report, was used to treat the pectus excavatum. Radiographic and Doppler echocardiographic examination 3 weeks and 4 months post-splinting documented resolution of both pectus excavatum and right ventricular outflow obstruction.

Pectus excavatum in two littermate dogs.

One male and 1 female, 8-week-old, schnauzer littermates were presented with moderate and mild pectus excavatum, respectively. External application of a coaptation splint to the ventral aspect of the thorax was used for correction of the sternal deformity in the male; conservative treatment was used in the female.

Surgical correction of pectus excavatum in two cats.

Two sexually intact male Bengal cats, one a 4-month-old weighing 2.8 kg and the other, a 3-month-old weighing 2.0 kg, were presented to the University of Missouri-Columbia Veterinary Teaching Hospital for evaluation of respiratory distress. On initial presentation, both cats were dyspneic, exercise intolerant, and had marked concave deformation of the caudal sternum. Surgical correction of pectus excavatum was performed using a cylindrical external splint and U-shaped external splint. Post-operative thoracic radiography revealed that there was decreased concavity of the sternum and increased thoracic height at the level of the caudal sternebrae in both cats.

Dynamic right ventricular outflow tract (infundibular) stenosis and pectus excavatum in a dog.

This is the first published report of a dog with dynamic right ventricular outflow tract (infundibular) stenosis, right ventricular hypertrophy, and pectus excavatum. A juvenile dog presented with a grade V/VI left base systolic heart murmur, tachycardia, and pectus excavatum. Diagnosis of the aforementioned conditions was based on radiography, electrocardiography, and echocardiography. At 9 1/2 wk of age the heart murmur was no longer audible and the right ventricular stenosis and hypertrophy had dissipated and regressed, respectively. Resolution may be associated with growth of the dog. A good prognosis is foreseen.

Use of internal splinting to realign a noncompliant sternum in a cat with pectus excavatum.

CASE DESCRIPTION: A 5.5-month-old female domestic longhair cat was examined because of dorsal deviation of the caudal aspect of the sternum and progressively worsening dyspnea during play activities. CLINICAL FINDINGS: A diagnosis of pectus excavatum was made clinically and confirmed radiographically. The cardiac silhouette was shifted into the right hemithorax. The vertebral index (VI) and frontosagittal index (FSI), which are radiographic indices used to grade the extent of the deformity, were 5.2 and 3.0, respectively. Minimum thoracic height was 13 mm at this time. TREATMENT AND OUTCOME: The sternal malposition was corrected during surgery; for stabilization, an internal splint was provided by use of a plate that was applied to the ventral side of the sternum. Radiographic indices improved until day 85; at that time, an increase in the distance between plate and sternum was detected, and plate removal was advised. The radiographic indices improved again after plate removal. At 310 days after surgery, VI was 9.6, FSI was 1.6, and minimum thoracic height was 34 mm. No dyspnea was evident during physical examination. CLINICAL RELEVANCE: Results of treatment suggest that this technique may be useful as an alternative surgical option for cats with pectus excavatum that have a noncompliant sternum.

Pectus excavatum surgically repaired using sternum realignment and splint techniques in a young cat.

Successful surgical repair of pectus excavatum deformities has so far only been reported in very young animals. This case report describes an alternative technique for repairing pectus excavatum in a young cat. The cat had shown moderate deformity with slight respiratory impairment when young and had experienced clinical problems with age. A sternum realignment technique involving a pin associated with an external splint was used. This alternative technique was a safe and efficient procedure in the five-month-old cat.

Atypical pectus excavatum in two Welsh terrier littermates.

Two six-week-old intact Welsh terrier littermates, a male and a female, were presented for congenital ventral thoracic wall deformities characterised by noticeable funnel-like depressions of the cranial sternum associated with inversion of the rib cage. No exercise intolerance or cardiac murmurs were noted. Thoracic radiographic examination revealed a significant dorsal deviation of the first to the fifth sternebrae. At 12 weeks of age, the thoracic depressions had improved markedly in both puppies. Thoracic radiography to reassess the sternal deviation was at this stage within normal limits, demonstrating complete radiographic resolution of the sternal deformity.