THE UNIVERSAL COMPUTERIZED TOMOGRAM INDEX FOR PECTUS EXCAVATUM: ADIEU INDEX

Abstract

SESSION TITLE: Cardiothoracic Surgery SESSION TYPE: Original Investigations PRESENTED ON: 10/09/2018 10:45 AM - 11:45 AM PURPOSE: Evaluation of the severity of pectus excavatum has relied on Haller Index. According to the fact that Haller index is inaccurate, we have developed and new indices that measure pectus deformities accurately in universally all diversities of the deformity. This study is to verify how our four-way computerized tomogram indexes (CTI) - ADiEU Index - work correctly and comprehend all morphological varieties. METHODS: From our database, the prospectively collected data for 2,794 patients with pectus excavatum repaired between 1999 and 2016 were analyzed. The ADiEU Index is 4-way measuring of the chest wall deformation that A for Asymmetry index to see how both sides of the chest wall are asymmetric; D for Depression index to measure the depth of the depression; E for Eccentricity index to measure how eccentric the location of the depression; and U for Unbalance index to measure both slopes of the excavation different. The indexes are defined as Asymmetry index (AI) is ratio of both chest wall heights; Depression index (DI) is ratio between the distances from the vertebra to the sternum (actual/proposed distance); Eccentricity index (EI) is ratio of horizontal distances at the point of depression; Unbalance index (UI) is ratio between two slopes of the excavated chest wall. RESULTS: The mean age of the patients was 10.7 years (3–55 years). The morphologic data obtained were of both the symmetric type (n=1481, 61.2%) and the asymmetric type (n=938, 38.8%). The asymmetric type was further described as eccentric (70.0%), unbalanced (19.2%) or combined (9.5%). The mean values of the CTIs were DI=1.84 (range: 1.05-35); AI=1.05 (range: 1-1.8); EI=1.54 (range: 1-3.75); and UI=1.50 (range: 1.05-6.0). Postoperative CTIs approached 1 in all indexes: Depression Index, 1.00 ±0.00 (p<0.001), Asymmetry Index, 0.98 ± 0.46 (p<0.001), Eccentricity Index, 1.01 ±0.01 (p<0.001), and Unbalance Index, 1.02 ±0.01 (p<0.001). Depression index was designed to measure directly the real depression of the chest wall. However, Haller index has a drawback by incorporating the width of the chest cage, which is not representing any degree of depression; the Correction index is not applicable in asymmetric morphology because it measures the height of one side chest wall. CONCLUSIONS: The ADiEU index seemed to effectively offer the degree of pectus deformity in four different perspectives, which makes easier to understand the morphology by adding volume to the deformity. Depression index represents the severity of the pectus excavatum accurately, whereas Haller index is incorrect, and Correction index is not appropriate for asymmetric types. CLINICAL IMPLICATIONS: The ADiEU index will be a universal guide for the selection of surgical repair techniques and a communication tool for each proposed deformity. Particularly, Haller index or Correction index needs to be replaced by Depression index to exclude wrong evaluation of the deformity. DISCLOSURES: No relevant relationships by Hyung Park, source=Web Response