Exaggerated Interventricular Dependence Among Patients With Pectus Excavatum: Combined Assessment With Cardiac MRI and Chest CT.

OBJECTIVE: We sought to explore whether patients with pectus excavatum have exaggerated interventricular dependence and to evaluate the impact of the malformation severity (assessed on CT) on both anatomic and functional cardiac parameters (assessed on cardiac MRI). SUBJECTS AND METHODS: The current study involved consecutive patients with a diagnosis of pectus excavatum who were referred to undergo cardiac MRI and chest CT to establish surgical candidacy or to define treatment strategies. RESULTS: Sixty-two patients with pectus excavatum underwent cardiac MRI and chest CT. Fifty (81%) patients were male, and the median age was 17.5 years (range, 14.0-23.0 years). Forty-seven (76%) patients had evidence of right ventricular compression. The left ventricle showed a significantly decreased end-diastolic volume (inspiration vs expiration: 70.4 ± 11.6 vs 76.1 ± 13.7 mL/m2, respectively; p = 0.01) and a significantly higher eccentricity index (1.52 ± 0.2 vs 1.20 ± 0.1, p < 0.0001) during inspiration than during expiration. The median respiratory-related septal excursion was 8.1% (interquartile range, 5.1-11.7%). Patients with pericardial effusion showed a significantly higher pectus excavatum severity index than patients without pericardial effusion (6.3 ± 3.4 vs 4.4 ± 1.3, respectively; p = 0.003). Patients with a relative septal excursion equal to or larger than 11.8% showed a significantly higher pectus excavatum severity index than patients with a relative septal excursion of less than 11.8% (6.3 ± 2.6 vs 4.7 ± 2.4, respectively; p = 0.05). CONCLUSION: In this study, patients with pectus excavatum showed significant alterations of cardiac morphology and function that were related to the deformation severity and that manifest as an exaggerated interventricular dependence.

Work-related upper limb musculoskeletal disorders in pediatric minimally invasive surgery: a multicentric survey comparing laparoscopic and sils ergonomy.

PURPOSE: Surgeons are at risk for developing work-related musculoskeletal symptoms (WMS). The present study aims to compare laparoscopy and SILS ergonomy among pediatric surgeons. METHODS: A questionnaire formed by 17 questions was mailed to 14 pediatric surgeons, seven with a large experience in laparoscopy and seven in SILS. All surgeons completed the survey. The questionnaires were focused on the type of laparoscopic or SILS activity, location and type of pain, need for drugs and its physical consequences. Results were analyzed using χ(2) test. RESULTS: Results indicated a similar incidence of WMS with shoulder symptoms (>75%) in both groups. In laparoscopic group this pain is evident only after a long lasting procedure, while in SILS group the pain is present after each procedure performed. SILS surgeons used painkillers and other therapies statistically more frequently than laparoscopic group (χ(2) = 0.001). CONCLUSIONS: This study confirms there is a strong association between WMS and MIS surgery. The incidence of pain is similar in both groups. Pain was present only after long lasting procedures in laparoscopic group, while SILS surgeons have pain after each procedure performed. In addition SILS surgeons use more frequently painkillers and other therapies compared to laparoscopic surgeons. In conclusion, it seems that SILS has a worse ergonomy compared to laparoscopy.

Exploring Parkinson's Disease-Associated Depression: Role of Inflammation on the Noradrenergic and Serotonergic Pathways.

Parkinson's disease (PD) is a multifactorial disease, with genetic and environmental factors contributing to the disease onset. Classically, PD is a movement disorder characterized by the loss of dopaminergic neurons in the nigrostriatal pathway and intraneuronal aggregates mainly constituted of the protein α-synuclein. However, PD patients also display non-motor symptoms, including depression, which have been linked to functional abnormalities of non-dopaminergic neurons, including serotonergic and noradrenergic ones. Thus, through this comprehensive literature review, we shed light on the noradrenergic and serotonergic impairment linked to depression in PD, focusing on the putative involvement of inflammatory mechanisms.

Novel techniques and future developments in minimally invasive pectus repair.

After the paradigm shift in the treatment of excavated deformities caused by the introduction of the Nuss technique in 1998, several innovative technical modifications and new treatment modalities have radically changed the surgical approach of pectus excavatum in the last couple of years. These new trends attain different topics. On one hand, the use of three-dimensional (3D) printing and implant customization surge as a possibility for a wider audience as 3D printers become available with lower costs. They provide the surgeon with new elements that enable precise planning, simulation, and customized prostheses amidst a tendency to abandon standardization and incorporate personalized medicine. Another topic comprises mandatory sternal elevation, in the continuous search for safety first always. Complete thoracic remodeling as a goal of repair instead of addressing only focal depressions, leaving the upper chest or focal protrusions unresolved. Finally, although the current surgical approach has evolved significantly, many groups still use lateral stabilizers or direct implant fixation with sutures or wires to the ribs. These systems continue to prove unreliable in preventing implant displacement. Fortunately, the bridge technique, described in this review, has come to address this sometimes fatal issue with encouraging results. We provide an updated overview of the latest developments regarding these concepts, related to the current state-of-the-art of the treatment of pectus excavatum.

The role of 3D printing in chest wall reconstruction.

Technology is advancing fast, and chest wall surgery finds particular benefit in the broader availability of three-dimensional (3D) reconstruction and printing. An increasing number of reports are being published on the use of these resources in virtual 3D reconstructions of chest walls in computed tomography (CT) scans, virtual surgeries, 3D printing of real-size models for surgical planning, practice, and education, and of note, the manufacture of customized 3D printed implants, changing the fundamental conception from a surgery that fits all, to a surgery for each patient. In this review, we explore the evidence published on simple chest wall reconstruction, including the use of 3D technology to assist in the improvement of the repair of the most frequent chest wall deformities: pectus excavatum and carinatum. Current studies are oriented to the automatization and customization of transthoracic implants, as well as education on real-size models. Next, we investigate the implementation of 3D printing in the repair of complex chest wall reconstruction, comprised of infrequent chest wall deformities such as pectus arcuatum and Poland syndrome. These malformations are very heterogeneous resulting in a high degree of improvisation during the surgical repair. In this setting, 3D technology plays a role in the standardization of a process that contemplates customization, concepts that may seem contradictory. Finally, 3D printing with biocompatible materials is rapidly becoming the first choice for the reconstruction of wide chest wall oncological resections. In this work, we review the first and most important current publications on the subject.

Lessons Learned after 176 Patients Treated with a Standardized Procedure of Thoracoscopic Cryoanalgesia during Minimally Invasive Repair of Pectus Excavatum.

BACKGROUND: Intrathoracic intercostal cryoanalgesia (Cryo) during minimally invasive repair of pectus excavatum (MIRPE) reports have been related to improved pain management, although its extent differs amongst studies. We aimed to report our experience using a standardized perioperative approach including Cryo during MIRPE, and compare our actual results with those of a previous thoracic epidural analgesia (TE) cohort. Lessons learned are summarized. METHODS: Retrospective study including patients undergoing Cryo during MIRPE between October 2018 and May 2023. Results with a standardized perioperative approach were analyzed. We then compared our Cryo cohort with a previous cohort of 62 patients who underwent TE and MIRPE between 2013 and 2018. Continuous variables were reported as mean and standard deviation, and as median (interquartile range) for variables with non-uniform distribution. RESULTS: We performed 176 Cryo during MIRPE (16.8 ± 4.6 years), with a mean postoperative length of stay (LOS) of 1.4 ± 0.8 days and a median total requirement of 7.5 (0.0; 15.0) oral morphine equivalents (OME) (mg). Patients with Cryo had a significantly lower mean LOS (1.4 ± 0.8 vs. 3.6 ± 1.0 days, p < 0.0001), and median total opioid requirement [7.5 (0.0; 15.0) vs. 77.4 (27.0; 115.5 OME (mg), p < 0.0001) compared to TE patients. Lessons learned included ensuring adequate contact of the cryoprobe with the target, proper exposition, and specialized multidisciplinary perioperative patient and family support, including psychology and physical therapy. CONCLUSIONS: In this study, we reported lessons learned after performing a standardized protocol of perioperative care in patients undergoing Cryo during MIRPE. This protocol enabled the achievement of a short LOS and low postoperative opioid requirement. TYPE OF STUDY: Retrospective comparative study. LEVEL OF EVIDENCE: III.

Unsophisticated assessment of the cardiopulmonary function in patients with pectus excavatum using the six minute walk test.

BACKGROUND: We explored whether the maximum predicted walking distance, assessed with six-minute walk test (6MWT) and reflecting submaximal functional exercise capacity, is decreased among patients with pectus excavatum (PEX). METHODS: This study comprised a retrospective analysis of patients with PEX who underwent a 6MWT for the assessment of functional capacity. The maximum distance walked was recorded and compared to reference values established for different populations, including a young and healthy South American population. RESULTS: We included 43 patients with PEX who underwent 6MWT. The mean age was 17.8 ± 6.7 years. The mean maximum distance walked was significantly lower than the predicted distance (600.8 ± 67.6 metres vs. 729.8 ± 67.5 metres, p < 0.0001). Using the Enright reference equation including an older reference population, the mean negative difference was higher (PEX patients walked 190.4 ± 78.4 metres less than predicted, p < 0.0001). We also applied the Li et al. reference equation accounting for sex among other variables, detecting a decreased walked distance compared to the gender-adjusted predicted distance (PEX patients walked a mean 222.4 ± 87.4 metres less than predicted, p < 0.0001). Using the Ulrich et al. equation, PEX patients walked a mean 114.2 ± 85.1 metres less than predicted (p < 0.0001). Although of uncertain clinical relevance, there was a significant decrease in the mean oxygen saturation after exercise (baseline 97.4 ± 1.2%, vs. final 96.4 ± 2.1%, p = 0.006). CONCLUSIONS: In this study, we identified a significant reduction in the maximum walked distance among patients with PEX compared to the predicted distance, thus potentially emerging as an unsophisticated means to evaluate and quantify functional exercise capacity.

Proposing the Retrosternal Angle as a Diagnostic Measure for Banana Sternum in Pectus Excavatum.

BACKGROUND/PURPOSE: Anteriorly convex sternum in pectus excavatum, also known as banana sternum (BS), influences decision-making during repair and, especially, the need to cross bars. However, the definition of BS remains subjective. Thus, we aim to propose the retrosternal angle (RSA) as a diagnostic measure for the discrimination of BS. MATERIAL AND METHODS: Retrospective analysis of a cohort of patients who underwent a minimally invasive repair of pectus excavatum (MIRPE) between October 2016 and October 2023 at our Pectus Clinic. Five expert thoracic surgeons individually reviewed their medical photographs and chest CT scans assigning patients to BS or non-BS groups based on consensus (≥4 surgeons). RSA measurements were obtained by an independent thoracic surgeon. RESULTS: Among 283 cases analyzed, 50 (18%) were classified as BS and 233 (82%) as non-BS. No significant differences were found between groups in age (p = 0.62), Haller index (p = 0.11), or Correction index (p = 0.58). However, RSA was significantly lower in the BS group (141.2 ± 8.4° vs. 154.5 ± 10.3°, p < 0.0001). Receiver operating characteristic curve analysis revealed RSA as a reliable predictor of BS (AUC 0.85, p < 0.0001), with a threshold of 148.5° demonstrating 80% sensitivity and 77% specificity. Regarding potential clinical implications, 26/50 (52%) of patients defined as BS underwent bar crossing, compared with 45/232 (19%) of those not considered a BS (p < 0.0001). CONCLUSION: This study proposes an objective metric, the Retrosternal Angle, to assess BS in chest CT scans, with a threshold of 148.5° showing high sensitivity and specificity. External validation of this angle and threshold is warranted in future investigations. TYPE OF STUDY: Retrospective comparative study. LEVEL OF EVIDENCE: III.

Novel index to estimate the cephalocaudal extent of the excavation in pectus excavatum: The Titanic index.

BACKGROUND/PURPOSE: Quantification of the severity of pectus excavatum deformities is currently performed using the Haller index (HI) and the Correction index (CI), amongst others. However, most indexes characterize the severity at the point of maximum excavation. We present a new index, the Titanic index (TI), aimed at the appraisal of the cephalocaudal extent of the excavation and its potential clinical use. MATERIALS AND METHODS: Retrospective analysis of a cohort of patients who underwent a minimally invasive repair of pectus excavatum (MIRPE) between July 2020 and April 2022 at a single center. We defined TI as the percentage of the sternum that lied behind the anterior costal line observed in the CT. Demographics, HI, CI, and TI calculated based on computed tomography images (CT) were analyzed. Also, we compared the severity indexes of two groups of patients divided by the number of implants introduced per patient (group A: two implants, and group B: more than two). RESULTS: Seventy-eight patients (92% male) were included, with a mean age of 17.2 ± 4.8 years. The mean TI was 37%. Albeit weak, we identified significant correlations between the TI and the HI and, more closely, to the CI. Two implants were introduced in 37 (47%) patients, and more than two in 41 (53%) patients. Compared to patients with two implants, the group of patients who received more than two implants were older and showed worse thoracic indexes. Using receiver operating characteristic curve analysis, we identified the TI as a better predictor of the need for more than two implants than HI and CI. In this regard, a TI larger than 66.5% had a sensitivity of 93% and a specificity of 92%. CONCLUSION: We propose a novel index for the categorization of the severity of pectus excavatum. This index might be useful in planning the number of implants required for complete thoracic remodeling during MIRPE. LEVEL OF EVIDENCE: Level III. TYPE OF STUDY: Retrospective Comparative Study.

Quantification of left ventricular myocardial collagen system in children, young adults, and the elderly.

Studies on the collagen system of the human myocardium are still limited compared to those on small laboratory animals. The aim of this work was to observe the collagen tissue of the myocardium of the human heart as a function of age. The types of collagen, as well as the density of collagen tissue and the diameter of collagen fibrils, were examined. Fragments of the left ventricular wall from 15 hearts, 5 from children, 5 from young adults, and 5 from elderly individuals, were analyzed by using the Picrosirius-polarization method and by transmission electron microscopy (TEM). The results showed the presence of collagen type III and collagen type I, both in the endomysium and perimysium of the 3 groups studied. Measurements of collagen content in myocardial tissue displayed that both endomysial and perimysial collagen increase in number and thickness in the adult and elderly. These histochemical results coincided with the observations obtained with the electron microscope in showing an increase in the number of collagen fibrils with a large diameter in the adult and elderly hearts. The present results on cardiac collagen may be important for assessing the pathogenesis of several cardiopathies in the hearts of children, young adults, and the elderly.

Short communication: ultrasound-guided percutaneous cryoanalgesia of intercostal nerves for uniportal video-assisted thoracic surgery.

BACKGROUND: Pain after thoracic surgery impairs lung function and increases the rate of postoperative pulmonary complications. Ultrasound-guided percutaneous cryoanalgesia of intercostal nerves constitutes a valid option for adequate postoperative analgesia. A key issue for a successful cryoanalgesia is placing the cryoprobe tip close to the intercostal nerve. This report describes an ultrasound technique using a high-resolution ultrasound probe to accomplish this goal. FINDINGS: Images of five anesthetized patients undergoing uniportal video-thoracoscopic surgeries are used as clinical examples. In the lateral position, a high-frequency 12 MHz probe is placed longitudinally at 5-7 cm parallel to the spine at the 4th, 5th, and 6th ipsilateral intercostal spaces. Ultrasound images detect the intercostal neurovascular bundle and a 14G angiocath is placed beside the nerve. The cryoprobe is inserted throughout the 14G catheter and the cryoanalgesia cycle is performed for 3 min. Two ultrasound signs confirm the right cryoprobe position close to the nerve: one is a color Doppler twinkling artifact that is seen as the quick shift of colors that delineates the cryoprobe contour. The other is a spherical hypoechoic image caused by the ice ball formed at the cryoprobe tip. CONCLUSIONS: Ultrasound images obtained with a high-frequency probe allow precise location of the cryoprobe tip close to the intercostal nerve for cold axonotmesis.

Remote treatment of pectus carinatum (Telepectus) during the COVID-19 pandemic.

BACKGROUND/PURPOSE: To report telemedicine's feasibility and satisfaction rates for treating patients with pectus carinatum using a dynamic compressor system. We analyzed treatment adherence in comparison with the previous, non-pandemic year. MATERIALS AND METHODS: Retrospective analysis including patients with pectus carinatum under treatment with a dynamic compressor system using telemedicine at the chest wall centers from two hospitals, private and public, between April and July 2020. A free video conference platform for teleconsultations was employed. We evaluated the incidence of pectus cases with telemedicine, the number of dynamic compressor system prescriptions, the number of patients in the correction phase, and the number who ended treatment. To assess adherence, we compared our cohort with an in-person cohort during the same time frame of the previous, non-pandemic year. In addition, we performed a patient satisfaction survey comprising questions related to socioeconomic status, the likeability of telemedicine, simplicity of modification of the system, and desire to continue with telepectus after the pandemic. RESULTS: One hundred and thirty-six telepectus consultations were performed in 76 patients. During this time frame, 15 patients started using the dynamic compressor system. Compared to the previous, non-pandemic year, the number of consultations per patient was similar (2019: 1.92 ± 1 .0 vs. 2020: 1.79 ± 0.8, p = 0.32), and there was a significant reduction in the number of dropouts with the use of telemedicine (9% vs. 1%, p = 0.025). Fifty-nine patients answered the satisfaction survey. All of them solved their doubts through telemedicine. Overall, 95% found telemedicine comfortable. Of note, those with a lower income evidenced the highest intention in continuing with telemedicine. CONCLUSIONS: We demonstrated the feasibility of remote care of patients with pectus carinatum using a dynamic compressor system with a similar frequency of consultations compared to in-person medical care. Telepectus patients revealed a high rate of satisfaction irrespective of their socioeconomic status. LEVEL OF EVIDENCE: IV. TYPE OF STUDY: Retrospective study.

Usefulness of strain cardiac magnetic resonance for the exposure of mild left ventricular systolic abnormalities in pectus excavatum.

BACKGROUND: Systolic dysfunction in pectus excavatum (PEX) is usually very subtle and mainly focused on the right ventricle (RV), leading to normal or unremarkable cardiac imaging findings unless involving exercise stress. OBJECTIVES: We evaluated systolic function in PEX using longitudinal strain cardiac magnetic resonance (CMR), a validated parameter for the assessment of the systolic deformation of subendocardial fibers. METHODS: This prospective registry comprised consecutive patients with PEX who were referred to CMR to define treatment strategies or to establish surgical candidacy. We also included a control group of 15 healthy volunteers without chest wall abnormalities. Using dedicated software, we evaluated the endocardial global longitudinal strain (GLS) of both ventricles and the endocardial global circumferential strain (GCS) of the left ventricle (LV). RESULTS: A total of 50 patients with PEX comprised the study population, with a mean age of 19.9 ± 8.0 years. The right ventricular ejection fraction (RVEF) of patients with PEX was significantly lower compared to the control group both at end-expiration (59.5 ± 6.8 vs. 64.7 ± 4.7%, p = 0.008) and end-inspiration (56.7 ± 7.2%, vs. 62.7 ± 4.4, p = 0.004); as well as the pulmonary stroke distance (12.6 ± 2.5, vs. 15.0 ± 2.0 cm, p = 0.001). The LV volumetric analysis revealed no differences between PEX and the control group (p > 0.05 for all) regardless of the respiratory cycle, with a mean expiratory LV ejection fraction (LVEF) of 61.4 ± 6.0%. In contrast, the GLS of the LV was significantly lower in PEX compared to controls (-21.2 ± 3.2 vs. -23.7 ± 3.0%, p = 0.010), whereas GCS was similar either at expiration (-28.5 ± 4.0%, vs. -29.5 ± 2.8, p = 0.38) or inspiration (-29.3 ± 4.1%, vs.-28.9 ± 2.3, p = 0.73). CONCLUSIONS: In this study, we demonstrated that longitudinal strain analysis might enable the detection of very subtle left ventricular systolic function abnormalities in patients with PEX, that are commonly overlooked using the conventional assessment. LEVEL OF EVIDENCE: II.

Pectus bar removal - why, when, where and how.

OBJECTIVE: Despite its less invasive nature, the widespread use of the minimally invasive repair of pectus excavatum (MIRPE) procedure has been associated with a significant number of serious complications. On the other hand, Pectus bar removal (PBR) is often considered a simple procedure and often scheduled in an outpatient setting. However, several studies report near-fatal complications not only during bar placement, but also during bar removal. The aim of our study was to clarify why a pectus bar should be removed, timing for removal, where PBR should be performed, and overall setup for safe removal. METHODS: A comprehensive review was performed in accordance with PRISMA guidelines, searching for articles published since 1998 in English. "Pectus bar removal AND (near-fatal) complications" were the applied terms. Inclusion criteria were articles reporting on the focus of PBR after MIRPE. Eligible study designs included (retrospective) case study series, case report and reviews. Full-text articles in which the technique in general was described were omitted. RESULTS: Recently published results of an online survey raised awareness about type and number of possible complications during PBR. Furthermore, our comprehensive literature review identified only a few, but serious complications during PBR. CONCLUSIONS: PBR has a high safety profile but in rare cases may be associated with major complications such as life-threatening hemorrhage from various thoracic sources. This risk is higher in patients with a history of complex MIPRE. In an effort to decrease these complications we recommend bilateral opening of surgical incisions, unbending the bar and meticulous mobilization of the bar. To manage these complications if they occur, we recommend removal in a hospital setting with adequate resources and personal including cardiac surgeons. If the postoperative course is uneventful discharge on the same day is reasonable.

Surgical Planning, Simulation, and Prosthesis Customization for Complex Chest Wall Malformations.

Despite the emergent application of 3-dimensional technology for thoracic reconstructions, reports regarding its use for the resolution of the heterogeneous subgroup of complex chest wall malformations are lacking. We aim to report a novel, standardized process of personalized repair of complex chest wall malformations comprising multidisciplinary, comprehensive surgical planning; surgical simulation on a 3-dimensionally printed scale model of the area of interest; manufacturing of customized prostheses; and surgical repair according to plan. We propose this therapeutic strategy for the resolution of such a wide variety of chest wall deformities to reduce improvisation and enhance outcomes.

Effects of aging on the secretory apparatus in the right atrial cardiomyocytes of rats.

The cardiac atria secrets polypeptide hormones usually called natriuretic peptides (NPs). These substances play a relevant role in the blood pressure regulation. The objective of the study was to estimate the effects of aging on the secretory apparatus of NPs in cardiomyocytes of the right atrium. Twenty male Wistar rats were studied: 10 young animals aged 3 months old (237 ±â€¯27 g; mean ±â€¯SD) and 10 old animals aged 20 months old (450 ±â€¯68 g; mean ±â€¯SD). The systolic blood pressure was verified instants before the moment of the euthanasia. Electron micrographs were prepared to quantify the area and density of the NP granules and the relative volumes of the endoplasmic reticulum, Golgi complex, and mitochondria. In addition, the number of pores per 10 µm of karyotheca was another variable evaluated. The significance of the results between the two groups evaluated was analyzed by the Student's t test (p < 0.05). The cardiomyocytes obtained from animals of the old group showed decreased in sectional area and density of secretory granules of NP and lower relative volume of endoplasmic reticulum, Golgi complex, and mitochondria compared with the young rats. Moreover, the quantitative density of nuclear pores was significantly lower compared with the youngers. CONCLUSION: Aging causes hypotrophy of the cardiomyocytes of right atrium, similar to what occurs in ventricular cardiomyocytes.

Safety-string: A handy maneuver to control pectus bar removal bleeding complications.

The pectus bar removal procedure is often considered a simple, straightforward surgery with a low incidence of complications. However, life-threatening bleeding complications have been reported requiring major measures for hemostatic control. Our objective is to share a simple maneuver that our group has systematically included in the bar removal procedure to facilitate bleeding control in case hemorrhage occurs.

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.

Diastolic and Systolic Cardiac Dysfunction in Pectus Excavatum: Relationship to Exercise and Malformation Severity.

PURPOSE: To explore stress echocardiographic findings among patients with pectus excavatum (PEX) and their relationship with malformation severity. MATERIALS AND METHODS: A prospective registry involving consecutive patients with a diagnosis of isolated PEX referred to undergo chest CT and stress echocardiography to evaluate surgical candidacy and/or to define treatment strategies was developed. Malformation indexes were evaluated using chest CT. RESULTS: This study included 269 patients with PEX (19.7 years ± 7.8 [standard deviation]; 245 men) and 35 healthy volunteers (20.7 years ± 6.1; 21 men). Patients with PEX achieved a lower maximal workload (PEX group, 8.2 metabolic equivalents ± 1.7; control group, 11.8 metabolic equivalents ± 5.5; P < .0001). This study identified evidence of abnormal right ventricular diastolic function in 29% of patients with PEX and identified no evidence of this among those in the control group (P < .0001). Healthy controls showed a 37% increment in the tricuspid area during exercise, compared with 4% in patients with PEX (P = .002). Right ventricular systolic function was significantly lower in patients with PEX than in controls, both measured using tricuspid annulus plane systolic excursion (stress, 25.0 mm ± 5.5 vs 35.4 mm ± 3.7; P < .0001), and the tricuspid systolic wave was also smaller (stress, 16.9 cm/sec ± 4.5 vs 20.5 cm/sec ± 3.9; P < .0001). During stress, significant associations were detected between malformation indexes with right ventricular systolic and diastolic findings (P < .05 for all). CONCLUSION: This study identified evidence of diverse adverse functional and morphologic cardiac manifestations in PEX, involving signs of abnormal diastolic and systolic right ventricular function and compression of the atrioventricular groove, which worsened during stress and were related to malformation severity.© RSNA, 2020: An earlier incorrect version of this article appeared online. This article was corrected on October 19, 2020.

Erratum: Diastolic and Systolic Cardiac Dysfunction in Pectus Excavatum: Relationship to Exercise and Malformation Severity.

[This corrects the article DOI: 10.1148/ryct.2020200011.].