Benefits Of Surgical Correction Research Articles

Abstract 11685: Effects of Pectus Excavatum Surgical Repair on Cardiac Volumes and Systolic Function as Assessed by 3D Transesophageal Echocardiography

Introduction: The consequences of external cardiovascular compression and cardiac displacement from pectus excavatum (PEx) are debated. The complex geometry of the right (RV) and left ventricle (LV) along with distortion from the extrinsic chest deformity pose significant limitations to reliable assessment of LV and RV volumes and function using transthoracic 2D-echocardiography in this population. Hypothesis: A 3D-echocardiography approach can reliably assess the effects of external cardiac compression and the benefits of surgical correction on RV and LV function in PEx patients. Methods: Adult patients undergoing minimally invasive repair of PEx between Oct-2021 and Feb-2023 were included in this prospective study. Intraoperative transesophageal (TEE) 6 beat full volume video loops incorporating LV and RV were captured and compared before and after surgical correction of the PEx. TomTec Software® was used for offline 3D/4D reconstruction ( Figure 1 shows changes in 3D RV and LV shape pre- and post-surgery). Result: The study included 102 patients (mean age of 32.1 ±11.8 years; Haller index 4.9 ±2.5; 60.8% males). Post PEx repair, there was a significant (p<0.001) increase in the 3D RV volumes, RV ejection fraction (EF), RV stroke volume and RV strain ( Figure 1 ). Additionally, there was a significant improvement in 3D LVEF, 3D LV strain (longitudinal and circumferential), LV twist, and torsion ( Figure 1 ). Conclusion: In this PEx cohort, 3D/4D TEE imaging demonstrated significant increases in RV volumes and in RV and LV systolic function after surgical repair. These findings support the negative cardiovascular consequences of PEx compression and benefits of surgical repair.

1329 Surgical Management of Longitudinal Vaginal Septum and Complete Uterine Septum

Video Objective To illustrate the steps for surgical correction of a longitudinal vaginal septum and complete uterine septum using narrative video footage. Setting A longitudinal vaginal septum and complete uterine septum are anomalies of Mullerian duct development that occur during embryological development. The exact incidence of Mullerian anomalies is difficult to determine, since women with them are often not diagnosed if asymptomatic, but is approximately 2-3%. In women who present with infertility, the incidence of uterine anomalies is often higher, approximately 5-10%. Although some women with vaginal anomalies are asymptomatic, some may note difficulty inserting tampons or dyspareunia. Reproductive outcomes in women with a complete uterine septum include possible decreased chance of implantation, and increased risk of spontaneous abortion and preterm labor/delivery. Benefits of surgical correction of a uterine septum include possible improved reproductive success and decreased poor obstetric outcomes. Interventions In this video, we illustrate the key surgical steps of excision of a longitudinal vaginal septum and hysteroscopic metroplasty for a complete uterine septum resection. Key surgical steps include: 1. Exam under anesthesia Lidocaine with epinephrine injection into vaginal septum. 2. Excision of septum with mayo scissors and re-approximation of vaginal mucosal edges. 3. Dilation of one side of cervical canal and placement of pediatric foley catheter to instill methylene blue-dyed fluid. 4. Hysteroscopic incision of septum using bipolar resectoscope until blue dye is visualized. 5. Complete incision of uterine septum. 6. Placement of uterine balloon for endometrial healing. 7. Vaginal packing placed to promote vaginal healing. Conclusion Surgical management of a longitudinal vaginal septum and complete uterine septum is a minimally invasive procedure to correct these Mullerian anomalies that could impact a woman's quality of life and possible reproductive success in the future.

Lung function after spinal fusion for adolescent idiopathic scoliosis

Journal of Paediatrics and Child HealthVolume 51, Issue 3 p. 350-350 Heads UpFree Access Lung function after spinal fusion for adolescent idiopathic scoliosis First published: 11 March 2015 https://doi.org/10.1111/jpc.12858_4AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat Progressive adolescent idiopathic scoliosis has a deleterious effect on lung function and quality of life. There is controversy regarding the benefits of surgical correction and the long-term effect on lung function. A prospective cohort study from a single centre in Edinburgh followed 12 patients (nine women) for a mean of 5.8 years (range 4.1–6.8 years) after combined anterior and posterior spinal fusion.1 Mean thoracic scoliosis was 101 (standard deviation (SD) 15)o pre- and 29 (SD 11)o post-operatively; lumbar scoliosis improved from 79 (range 60–115)o to 29 (SD 18–40)o. The mean forced expiratory volume in 1 s (FEV1) increased from 2.0 to 2.4 L, and the forced vital capacity (FVC) increased from 2.4 to 2.8 L. Both increases were statistically significant, but the children also grew by a mean of 6 cm, and the SD z-scores for FEV1 and FVC were virtually identical before and after surgery. Quality of life measured by questionnaire improved significantly at 2 years and even further at long-term follow-up, irrespective of lung function. This uncontrolled study showed that lung function was preserved following spinal surgery while quality of life improved. Reference 1Urquhart DS et al. Arch. Dis. Child. 2014; 99: 922– 926. CrossrefCASPubMedWeb of Science®Google Scholar Reviewer: David Isaacs, david.isaacs@health.nsw.gov.au Volume51, Issue3March 2015Pages 350-350 ReferencesRelatedInformation

The adverse effect of hydrosalpinges on in vitro fertilization pregnancy rates and the benefit of surgical correction

Objective: To test the hypothesis that IVF-ET pregnancy rates (PRs) for patients with tubal factor infertility are decreased in patients with hydrosalpinges and that surgical correction reverses this effect. Design: Retrospective chart review. Setting: Private practice IVF-ET program. Patient(s): Patients ( n = 160) undergoing 238 cycles of IVF-ET were stratified into groups based on the presence of hydrosalpinges and whether surgical correction had been performed. Patients > 39 years old and patients with male factor infertility were excluded from the study. Intervention(s): Patients with hydrosalpinges were offered surgical correction. Main Outcome Measure(s): Clinical pregnancy defined by an intrauterine gestational sac. Result(s): Patients with hydrosalpinges had significantly decreased implantation rates and PRs per transfer (2.8% and 8.5%, respectively) than patients with tubal factor infertility but without hydrosalpinges (15.7% and 38.6%). Surgical correction improved implantation rates and PRs in patients with prior failed cycles (16.1% and 37.5%) and in patients undergoing surgery before IVF-ET (21.8% and 51.7%). The type of surgery performed did not affect success rates in the small number of patients evaluated. Conclusion(s): The presence of a hydrosalpinx during an IVF-ET cycle results in significant decreases in implantation rates and PRs. Surgical treatment of hydrosalpinges before IVF-ET cycles improves implantation rates and PRs.