Congenital Chest Wall Deformity Research Articles

Pectus excavatum and carinatum: a narrative review of epidemiology, etiopathogenesis, clinical features, and classification.

A wide variety of congenital chest wall deformities that manifest in infants, children and adolescents exists, among which are pectus excavatum and pectus carinatum. Numerous studies have been conducted over the years aiming to better understand these deformities. This report provides a brief overview of what is currently known about the epidemiology, etiopathogenesis, clinical presentation, and classification of these deformities, and highlights the gaps in knowledge. A search was conducted for all the above-described domains in the PubMed and Embase databases. A total of 147 articles were included in this narrative review. Estimation of the true incidence and prevalence of pectus excavatum and carinatum is challenging due to lacking consensus on a definition of both deformities. Nowadays, several theories for the development of pectus excavatum and carinatum have been suggested which focus on intrinsic or extrinsic pathogenic factors, with the leading hypothesis focusing on overgrowth or growth disturbance of costal cartilages. Furthermore, genetic predisposition to the deformities is likely to exist. Pectus excavatum is frequently associated with cardiopulmonary symptoms, while pectus carinatum patients mostly present with cosmetic complaints. Both deformities are classified based on the shape or severity of the deformity. However, each classification system has its limitations. Substantial progress has been made in the past few decades in understanding the development and symptomatology of pectus excavatum and carinatum. Current hypotheses on the etiology of the deformities should be confirmed by biomedical and genetic studies. For clinical purposes, the establishment of a clear definition and classification system for both deformities based on objective morphologic features is eagerly anticipated.

Ovine model of congenital chest wall and spine deformity: From birth to 3 months follow-up.

The evolution and treatment of lung alterations related to congenital spine and chest wall deformities (CWD) are poorly understood. Most animal models of CWD created postnatally were not evaluated for respiratory function. The goal of our study was to evaluate the effects of a CWD induced in utero on lung growth and function in an ovine model. A CWD was induced in utero at 70-75 days of gestation in 14 ovine fetuses by resection of the 7th and 8th left ribs. Each non-operated twin fetus was taken as control. Respiratory mechanics was studied postnatally in the first week and at 1, 2, and 3 months. Post-mortem respiratory mechanics and lung histomorphometry were also assessed at 3 months. Eight out of 14 CWD lambs (57%) and 14 control lambs survived the postnatal period. One severe and five mild deformities were induced. At birth, inspiratory capacity (25 vs. 32 mL/kg in controls), and dynamic (1.4 vs. 1.8 mL/cmH2O/kg), and static (2.0 vs. 2.5 mL/cmH2O/kg) respiratory system compliances were decreased in CWD lambs. Apart from a slight decrease in inspiratory capacity at 1 month of life, no other differences were observed in respiratory mechanics measured in vivo thereafter. Postmortem measurements found a significant decrease in lung compliance-for each lung and for both lungs taken together-in CWD lambs. No differences in lung histology were detected at 3 months in CWD animals compared to controls. Our study is the first to assess the effects of a prenatally induced CWD on lung development and function from birth to 3 months in an ovine model. Our results show no significant differences in lung histomorphometry at 3 months in CWD lambs compared to controls. Resolution at 1 month of the alterations in respiratory mechanics present at birth may be related to the challenge in inducing severe deformities.

Automatic implant shape design for minimally invasive repair of pectus excavatum using deep learning and shape registration

Minimally invasive repair of pectus excavatum (MIRPE) is an effective method for correcting pectus excavatum (PE), a congenital chest wall deformity characterized by concave depression of the sternum. In MIRPE, a long, thin, curved stainless plate (implant) is placed across the thoracic cage to correct the deformity. However, the implant curvature is difficult to accurately determine during the procedure. This implant depends on the surgeon’s expert knowledge and experience and lacks objective criteria. Moreover, tedious manual input by surgeons is required to estimate the implant shape. In this study, a novel three-step end-to-end automatic framework is proposed to determine the implant shape during preoperative planning: (1) The deepest depression point (DDP) in the sagittal plane of the patient’s CT volume is automatically determined using Sparse R-CNN-R101, and the axial slice containing the point is extracted. (2) Cascade Mask R-CNN-X101 segments the anterior intercostal gristle of the pectus, sternum and rib in the axial slice, and the contour is extracted to generate the PE point set. (3) Robust shape registration is performed to match the PE shape with a healthy thoracic cage, which is then utilized to generate the implant shape. The framework was evaluated on a CT dataset of 90 PE patients and 30 healthy children. The experimental results show that the average error of the DDP extraction was 5.83 mm. The end-to-end output of our framework was compared with surgical outcomes of professional surgeons to clinically validate the effectiveness of our method. The results indicate that the root mean square error (RMSE) between the midline of the real implant and our framework output was less than 2 mm.

Complications and Outcomes of the Nuss Procedure in Adult Patients: A Systematic Review.

Pectus excavatum is a congenital chest wall deformity, commonly identified in early childhood, creating a "sunken chest" appearance. Over time, the deformity can worsen, thus impacting cardiopulmonary function and creating significant body image disturbance in patients. The Nuss procedure is a minimally invasive technique in which a curved steel bar is introduced underneath the sternum through small bilateral thoracic incisions to correct the deformity. Most studies regarding the procedure to date focus on outcomes and complications in pediatric patients, however, few studies discuss these results in adult patients. This systematic review aims to analyze common complications and outcomes in patients over the age of 18 who have not undergone any prior intervention for pectus excavatum. The most common complications experienced in adult patients were displacement of the implanted steel bar, infection of the surgical site, pneumothorax, pleural effusion, and chronic postoperative pain. Reoperation was common in patients with a displacement of the bar, chronic pain, and bleeding. Additionally, adult patients routinely required a higher number of steel bars to be placed to correct the deformity. Despite evidence that the rate of complications increases with age, the majority of adult patients in our included studies were satisfied with the outcome of the procedure with indications of improved self-image and reduced preoperative symptoms such as dyspnea on exertion, palpitations, chest pain, and depression.

Impact of pectus excavatum on pulmonary function and exercise capacity in patients treated with 3D custom-made silicone implants

Pectus excavatum (PE) is the most common congenital chest wall deformity, whose cardiopulmonary consequences are controversial. PE surgery is in our experience usually performed for aesthetic reasons. The aim of this study was to evaluate the impact of PE on respiratory function and exercise capacity in patients with PE before patient-specific silicone implant correction. This monocentric prospective study conducted at Toulouse University Hospital included sixty patients scheduled for custom-made silicone implants correction. Respiratory function (pulmonary function tests (FPTs)) and exercise capacity (VO2 max) were measured before surgery. Before surgery, no (0/60) restrictive lung disease was detected, with a mean total lung capacity (TLC) of 98.5% of predicted value (IC 95%; 80.4-137). Median VO2 max (n=56) was normal (89% predicted), with no cardiac limitation. In this cohort, PE had no impact on respiratory function nor exercise capacity. In patients without cardiac or respiratory effects of PE, silicone implants should be considered the preferred approach as it adequately addressed patients' main complaint of low self-esteem.

Surgical treatment of a sternal cleft associated with pectus excavatum

Sternal cleft is a rare congenital chest wall deformity, with a reported incidence of 1 in 100,000 live births, accounting for less than 1% of all chest wall deformities. Patients with sternal clefts can be asymptomatic; however, most cases have recurrent respiratory infections and cosmetic disfigurement. Therefore, surgical correction of this deformity is still necessary to address cosmetic issues, assuage parental concerns, and prevent repeated respiratory infections caused by paradoxical breathing patterns. Here, we report a case of complete sternal cleft associated with pectus excavatum that was successfully treated with sternal reconstruction and pectus bar insertion.

Dynamic Compression Therapy for Pectus Carinatum in Children and Adolescents: Factors for Success

BackgroundPectus carinatum (PC) is a congenital chest wall deformity. In childhood, it is increasingly treated with dynamic compression therapy. Factors for success for dynamic brace therapy are relatively unknown. MethodsBetween 2013 and 2020, 740 patients treated with the Dynamic Compression System (DCS), were studied. This included the effect of age, gender, pectus height, symmetry and pectus rigidity on treatment time and symptoms with linear multiple regression analyses. ResultsCarinatum height and high pressure of initial correction at the start of treatment were associated with a prolonged duration of treatment. For each cm increase in carinatum height, the total treatment duration increased with 1.9 months (p-value= 0.002, 95% CI: 0.70–3.13). An initial correction pressure of ≥7.6 pounds per square inch (psi), increased the treatment duration with 3.5 months (p-value 0.006, 95% CI: 1.04–6.01) compared to an initial correction pressure of ≤5.0 psi. A high initial pressure of correction of ≥7.6 psi increased the odds of having somatic symptoms with 1.19 (p-value= 0.012, 95% CI: 1.04–1.45) and psychosocial symptoms with 1.13 (p-value= 0.04, 95% CI: 1.01–1.27) compared to a low initial pressure of correction of ≤5.0 psi. An initial pressure of correction of 5.1–7.5 psi increased the odds of having somatic symptoms with 1.14 (p-value 0.046, 95% CI: 1.00–1.29) compared to an initial pressure of correction of ≤5.0 psi. Patients with asymmetric chests were more likely to abandon therapy ConclusionsHigh carinatum height and high initial pressure of correction are associated with prolonged bracing treatment and a higher failure rate. Level of EvidenceIII

Clinical and immunological assessment of APDS2 with features of the SHORT syndrome related to a novel mutation in PIK3R1 with reduced penetrance.

Monoallelic loss-of-function (LOF) mutations in the phosphatidylinositol 3-kinase (PIK3R1) gene affecting the inter-Src homology 2 domain of the p85α regulatory subunit of phosphoinositide--3-kinase δ (PI3Kδ) cause the activated PI3K δ syndrome (APDS2). APDS2 is defined as a primary antibody deficiency, developmental abnormalities within the B and T lymph cell compartments, and immune dysregulation. The genetic defect of APDS2 is shared with that of the SHORT syndrome, characterized by short stature, joint hyperextensibility, ocular depression, Rieger anomaly, and delayed tooth eruption. LOF variants in an intronic splice site (c.1425+1G.C/A/T) in the PI3KR1 gene have been identified in patients affected with both APDS2 and SHORT syndrome. Herein, we report a novel c.1644-1648del (p.Asp548Glufs*6) variant in a pediatric patient with the APDS2-related immunodeficiency, who presents with mild phenotypic features of the SHORT syndrome, congenital chest wall deformity, and IgE-mediated food allergy. The same variant was also identified in the patient's hitherto asymptomatic mother, implicating an incomplete penetrance. Regular monitoring by a multidisciplinary team under the pediatric clinical immunologist's supervision to implement appropriate diagnostic procedures and treatment modalities is of paramount importance. Further studies are required to better define the genotype-phenotype correlation in patients with the PIK3R1 gene mutations and to better delineate the mutual relationship between APDS2 and the SHORT syndrome.

Ovine model of congenital chest wall and spine deformity with alterations of respiratory mechanics: follow-up from birth to three months.

Ovine model of congenital chest wall and spine deformity with alterations of respiratory mechanics: follow-up from birth to three months.

Doctor, My Chest is Deformed…..

Congenital chest wall deformities occurred in roughly 1% of children and if asymptomatic are often overlooked and taken lightly. This results in a progressive deformity of the chest and delays in diagnosis of the underlying causes. Complications can also develop from the underlying condition. Chest wall deformities are associated with a number of syndromes and other anomalies including abnormalities of the diaphragm. Congenital Diaphragmatic Hernia (CDH) is one of the underlying causes of chest deformity. Congenital Morgagni Hernia (CMH) is a rare form of CDH and consists of 3-5% in all CDH. Many cases were delayed in diagnosis due to the subtle presentation or were incidental findings. The consequence of delay in diagnosis can lead to the onset of complications which carries morbidities and even mortality. We report a case of a child with missed diagnosis of a rare condition Morgagni Diaphragmatic Hernia presenting with chest deformity.

Translation and psychometric evaluation of the Swedish versions of the Nuss Questionnaire modified for Adults and the Single Step Questionnaire

BackgroundPectus excavatum (PE) is the most common congenital chest wall deformity. Most individuals with PE suffer from psychosocial problems, with low self-esteem and poor body image. Correctional surgery for PE is available, the most widely used is the Nuss procedure. The Nuss procedure has previously been reported to improve self-esteem, body image and health-related quality of life (HRQoL). To assess HRQoL among individuals with PE, the Nuss Questionnaire modified for Adults (NQ-mA) and Single Step Questionnaire (SSQ) has been developed. The aim of the current study was to translate and culturally adapt NQ-mA and SSQ to fit a Swedish context, and to evaluate the psychometric properties, and validate the culturally adapted versions.MethodsIndividuals who had undergone the Nuss procedure for pectus excavatum were invited to participate in a multicentre study with cross-sectional design. HRQoL was assessed by NQ-mA, SSQ and RAND-36. Psychometric properties for NQ-mA and SSQ were evaluated by content validity index and construct validity (exploratory factor analysis, confirmatory factor analysis, and inter-scale correlations). Known-groups validity, as well as floor and ceiling effects, were evaluated. Internal consistency reliability was examined using Cronbach’s alpha.ResultsIn total 236 individuals participated in the study. Content validity index for NQ-mA showed satisfactory results, except for two items. Factor analysis for NQ-mA suggested a two-factor model, with exclusion of two items. Subscales correlated adequately with RAND-36’s domains. Known-groups validity for NQ-mA demonstrated high sensitivity for between-group differences. Ceiling effects were present in several items. Cronbach’s alpha for NQ-mA was .89. Confirmatory factor analysis for SSQ resulted in a three-factor model, with exclusion of five items. However, this model was shown to be unstable through further exploratory factor analysis testing, and no further psychometric tests were conducted for SSQ.ConclusionThe 10-item Swedish version of NQ-mA was shown to be valid for research and clinical assessment of HRQoL in individuals with pectus excavatum. The Swedish version of SSQ requires revision of items before further validation can be performed.

Canadian Spine SocietyPresentation CPSS1: Spinal insufficiency fracture in the geriatric pediatric spinePresentation CPSS2: The clinical significance of tether breakages in anterior vertebral body growth modulation: a 2-year postoperative analysisPresentation CPSS3: Anterior vertebral body growth modulation for idiopathic scoliosis: early, mid-term and late complicationsPresentation CPSS4: Ovine model of congenital chest wall and spine deformity with alterations of respiratory mechanics: follow-up from

Canadian Spine SocietyPresentation CPSS1: Spinal insufficiency fracture in the geriatric pediatric spinePresentation CPSS2: The clinical significance of tether breakages in anterior vertebral body growth modulation: a 2-year postoperative analysisPresentation CPSS3: Anterior vertebral body growth modulation for idiopathic scoliosis: early, mid-term and late complicationsPresentation CPSS4: Ovine model of congenital chest wall and spine deformity with alterations of respiratory mechanics: follow-up from

A Comparative Study on Short-Term Effects of Compression Orthosis and Exercises in the Treatment of Pectus Carinatum: A Randomized Controlled Pilot Feasibility Trial.

Pectus carinatum (PC) is a congenital chest wall deformity which is characterized by the protrusion of the sternum and costal cartilages. Although orthotic and exercise therapies are commonly offered by physicians for PC treatment, there is a lack of evidence on the benefits of exercises and how long the orthosis should be worn. The aim of this study is to investigate the effects and feasibility of custom-made compression orthosis and exercises in the treatment of PC. Patients with PC aged 7 to 17 years old were randomized into three groups: compression orthosis 23 hours, compression orthosis 8 hours, and control group. All groups received exercises for 1 hour a day for 3 weeks. Additionally, compression orthosis 23 hours group wore the orthosis for 23 hours a day, while compression orthosis 8 hours group wore the orthosis for 8 hours a day. PC protrusion, pressure of correction, thorax lateral and anteroposterior parameters, external chest wall measurements, and Nuss Questionnaire were evaluated before and after the treatment. Also, adverse effects, retention, and compliance were assessed. Feasibility was evaluated by calculating the percentages of recruitment, retention, and safety. The compression orthosis 23 hours group showed greater improvements than the other groups. After treatment, all groups showed significant changes in protrusion, pressure of correction, and external chest wall measurements. Adverse events occurred with similar frequency across groups. Retention percentages did not differ among groups. Compression orthosis use for 23 hours can be recommended rather than its use for 8 hours because 23 hours of orthosis use has better correction and similar adverse effects.

Three-dimensional printing flexible models: a novel technique for Nuss procedure planning of pectus excavatum repair.

Pectus excavatum (PE), one of the most common congenital chest wall deformities, is characterized by posterior depression of the sternum and lower costal cartilages. In this study, we demonstrated the application of flexible three-dimensional printing thoracic models for surgical approach planning of extrapleural Nuss procedure for patients with pectus excavatum. Six patients with pectus excavatum were referred to our hospital for extrapleural Nuss procedure. Each patient's chest was reconstructed based on their computed tomography imaging data, and the three-dimensional (3D) thoracic model was manufactured with flexible material using 3D printing technique. The individual surgical approach and custom-made steel bars were designed and produced using these models. The surgical approach was evaluated by using the three-dimensional thoracic model. In all patients received extrapleural Nuss surgery, it has been proven the uniformity of repair efficacy in both models and patients. Moreover, an individualized and well-fitting steel bar can be fabricated once the surgical approach was confirmed. All the steel bars were loaded against the ribs rigorously and seamlessly. The flexible three-dimensional thoracic models were very helpful for the preoperative planning of extrapleural Nuss procedure.

Pectoralis Muscle Transposition in Association with the Ravitch Procedure in the Management of Severe Pectus Excavatum.

Background:Pectus excavatum (PE) is the most common congenital chest wall deformity. PE is sometimes associated with cardiorespiratory impairment, but is often associated with psychological distress, especially for patients in their teenage years. Surgical repair of pectus deformities has been shown to improve both physical limitations and psychosocial well-being in children. The most common surgical approaches for PE treatment are the modified Ravitch technique and the minimally invasive Nuss technique. A technical modification of the Ravitch procedure, which includes bilateral mobilization and midline transposition of the pectoralis muscle flap, is presented here.Methods:From 2010 to 2016, 12 patients were treated by a modified Ravitch procedure with bilateral mobilization and midline transposition of the pectoralis muscle flap for severe PE. Outcomes, morphological results, and complications were analyzed with respect to this new combined surgical approach.Results:There was a statistically significant difference between pre- and postoperative values (P = 0.0025) of the Haller index at the 18-month follow-up, showing a significant morphological improvement for all treated patients. After surgery, no morbidity and mortality were noted. The mean hospital stay was 7 days, and all patients were discharged without major complications.Conclusion:This technique significantly improved patients’ postoperative morphological outcomes and significantly reduced long-term complications, such as wound dehiscence, skin thinning, and hardware exposure.

Short-term Outcomes After Pectus Excavatum Repair in Adults and Children

BackgroundPectus excavatum is a common congenital chest wall deformity often repaired during adolescence, although a subset of patients undergo repair as adults. The goal of our study was to determine the effects of age at repair and repair technique on short-term surgical outcomes. Materials and methodsWe performed a cohort study of patients in the 2012 to 2016 American College of Surgeons National Surgical Quality Improvement Project pediatric (age<18 y) and adult databases who underwent pectus excavatum repair. The primary outcome was the incidence of 30-d complications. Secondary outcomes included length of stay, reoperation, and readmission. Multivariable logistic regression was used to estimate the independent effects of patient age and type of repair on postoperative outcomes. ResultsOf the 2268 subjects included, 2089 (92.1%) were younger than 18 y. Overall, 3.4% of patients suffered a 30-d complication, and the risk was similar between age groups (risk ratio [RR], 0.69; 95% confidence interval [CI], 0.08-5.03; P = 0.731). Steroid therapy was an independent risk factor for complications (RR, 8.0; 95% CI, 1.9-19.7; P = 0.006). Median length of stay was 4 d (interquartile range, 3-5) and was similar between age groups. Risk for readmission and reoperation were 2.8% and 1.5%, respectively, and were similar for pediatric and adult patients. When comparing minimally invasive repair with and without thoracoscopy, risk for 30-d complications was lower among patients repaired with thoracoscopy (RR, 0.56; CI, 0.32-0.96; P = 0.034). ConclusionsPediatric and adult patients experience comparable rates of postoperative complications, readmission, and reoperation after pectus excavatum repair. Use of thoracoscopy during minimally invasive repair is associated with lower risk of complications. These findings suggest that thoracoscopy should be used routinely for minimally invasive repair of pectus excavatum.

PECTUS EXCAVATUM AND ATYPICAL MYCOBACTERIAL PULMONARY DISEASE

SESSION TITLE: Imaging SESSION TYPE: Med Student/Res Case Rep Postr PRESENTED ON: 10/09/2018 01:15 pm - 02:15 pm INTRODUCTION: NTM ( nontuberculous mycobacterial disease ) has been well reported in immunocompetent hosts. MAC (Mycobacterium Avium Complex ) is the most widely encountered form of NTM disease. The clinical presentation and radiographic imaging differs based on whether the patient has pre existing lung disease. In immunocompetentpatients without pre exisiting lung disease MAC is typically encountered in non smoking females greater than 50 years of age. Additional patient specific risk factors are poorly understood. The association between chest wall deformities and MAC lung disease has been previously described but not commonly appreciated by clinicians and radiologists. CASE PRESENTATION: 44 y/o f with a history of Vitamin D deficiency, Thallasemia minor and GERD presented for outpatient pulmonary evaluation of abnormal CT imaging associated with a + PPD. The patient is employed in a hospital setting as a nurse and has had multiple prior PPDs which were + with negative CXR imaging. She had received BCG vaccination as a child in Albania and was never previously treated for latent tuberculosis. On a routine physical evaluation for a new position she was required to have a new CXR performed which revealed subtle airspace and reticular densities in the bilateral mid lung fields. She had a subsequent gamma interferon assay (Qunatiferon GOLD) performed which was negative and was referred for CT imaging and additional pulmonary evaluation to rule out tuberculosis. The patient reported intermittent productive cough with discolored sputum for several years. She denied any weight loss, night sweats, hemoptysis or any known TB exposure. CT chest revealed evidence of bronchiectasis in the RML and lingula associated with centrilobular tree in bud opacities. Additionally on CT imaging and physical exam the pt was noted to have a pectusexcavatum deformity of the chest wall. 3 sets of sputum AFB were + MAC. Treatment was started with ethambutol, rifampin, clarithromycin on a 3 time weekly basis with significant improvement in symptoms. DISCUSSION: Pectus Excavatum, also known as sunken or funnel chest, is a congenital chest wall deformity in which several ribs and the sternum grow abnormally, producing a concave, or caved-in, appearance in the anterior chest wall. Chest wall deformities including pectusexcavatum have been associated with MAC lung disease more so than tuberculous lung disease, but the precise mechanism is poorly understood and not commonly appreciated by clinicians and radiologists. CONCLUSIONS: The combination of a pectus deformity with RML and lungula bronchiectasis in an immunocompetenthost should immediately raise the concern of MAC lung disease. Additional research is warranted to better elucidate risk factors for pulmonary NTM disease. Reference #1: 1- Cherra Pumphrey, MD , Abigail Chandler, MD and et al.MAC Infection in a Man With Pectus Excavatum. November 01, 2007. Pediatr Surg Int. 2001;17:344-350. 4. Reference #2: 2- Honda JR, Knight V, Chan ED. Pathogenesis and risk factors for nontuberculous mycobacterial lung disease. Clin Chest Med. 2015;36:1-11. DISCLOSURES: No relevant relationships by Mona Alipour, source=Web Response No relevant relationships by Farhad Arjomand, source=Web Response No relevant relationships by Louis Gerolemou, source=Web Response No relevant relationships by Nabil Mesiha, source=Web Response No relevant relationships by Viswanath Vasudevan, source=Web Response

Long-Term Results of Compressive Brace Therapy for Pectus Carinatum

Pectus carinatum (PC) is one of the most common types of congenital chest wall deformity. Recently, noninvasive compressive brace therapy has been more frequently used than invasive surgical correction to treat PC. Hence, the purpose of this study was to determine the long-term outcome of compressive brace therapy. We retrospectively reviewed patients with PC who underwent compressive brace therapy between January 2014 and December 2016. All patients underwent a 2-week compression period, in which braces were worn for 20 hours per day, followed by a 6-month maintenance period, in which braces were worn for 12 hours per day. Patient satisfaction was investigated via telephone survey. A total of 320 patients were included in this study. The average age was 13 years, and 280 were males (87.5%). The median follow-up period was 42 months (13-68). Good compliance was observed in 286 patients (89.4%; compliance group). In this group, the initial Haller index significantly increased from 2.20 ± 0.31 to 2.59 ± 0.38 after the 6-month therapy period (p = 0.001). After the 6-month period, 255 patients (89.1%) and 31 patients (12.1%) in the compliance group were very satisfied and satisfied, respectively. Satisfaction at the last follow-up via telephone survey was very satisfied in 250 patients (87.4%) and satisfied in 36 (12.6%). In the compliance group, no patient needed compressive braces again after the therapy period. Given the findings presented in this study, compressive brace therapy appears to be a relatively simple and safe method with good long-term outcome in treating patients with PC.

Repair of Sternal Cleft in Children

The goal of this paper is to review the surgical techniques for the correction of sternal cleft in children. Various surgical techniques have been developed for the correction of sternal cleft since 1949, when the first successful repair was reported. Sternal cleft is an uncommon congenital chest wall deformity. The optimal correction can be achieved by primary repair of the defect in patients younger than 1 year of age, especially during the neonatal period, mostly with an easy technique. In older children, more extensive techniques are applied, using either autologous tissues or synthetic prosthetic materials, with satisfactory functional and aesthetic results.

Severe pectus excavatum with tracheal compression presenting with chronic cough

Abstract While pectus excavatum is the most common congenital chest wall deformity in children, indications for surgical repair are still debated among experts. Some centers require demonstration of physiologic criteria prior to repair, even in the face of significant anatomic compression. We present a case of a 16-year-old male with severe pectus excavatum who presented with a 3-year history of a chronic barking cough and exercise-induced shortness of breath. Radiographic imaging demonstrated compression of the trachea and bilateral mainstem bronchi secondary to severe pectus excavatum deformity. Despite his severe pectus deformity, preoperative physiologic testing demonstrated normal to near-normal cardiopulmonary function. Minimally invasive repair of the chest wall defect (modified Nuss procedure) provided rapid alleviation of symptoms, and a significant improvement in quality of life.