Pectus Carinatum
Everything in the library about pectus carinatum — built automatically from the recorded discussions that name it
Educational content from recorded physician discussions — not medical advice. Always talk to your child's care team about your child's situation.
Content of this collection
Fundamentals
1 item
Pectus Arcuatum a Pectus Unlike any Other
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New article you should know about From JPS by Dr. Cecilia GIgena
"Pectus Arcuatum: A Pectus Unlike Any Other"
Authors: Sarah Abdellaoui, Aurélien Scalabre, Christian Piolat, Frédéric Lavrand, Amane-Allah Lachkar, Anne Lehn, Clémence
video0:51 · Jan 2024
Diagnosis & Workup
3 items
Pectus - Preoperative Assessment - Genetics
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Dr. Derek E, Neilson discusses thegenetic evaluation for a pectus excavatum. Dr. Neilson elaborates on the evaluationtechniques used which include primarily Marfan syndrome, the skeletal evaluation or physical findings, as well as thecardia
video9:54 · Nov 2018
Pectus - Preoperative Assessment - Radiology and Cardiac Evaluation
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Dr. Todd Ponsky introduces the chair of the event, Dr. Victor F. Garcia, founding director, trauma services. Dr. Garciaintroduces the event panel. Dr. Rebeccah L. Brown starts the even by presenting a case study of a thirteen year old male
video44:03 · Nov 2018
Genetics: Pectus Innovations
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Dr. Derek E. Neilson discusses the genetic evaluation of pectus excavatum. Dr. Neilson discusses both Marfan syndrome and Ehlers-Danlos syndrome, as well as the work-up needed for diagnosis of both of these disorders.
video9:48 · Jan 2019
Surgical Management
5 items
Pectus Deformities: Update Course 2015
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Dr. Whit Holcomb discusses pectus deformities. His presentation includes nickel allergy testing instances, how to prevent infection and avoid cardiac injurywith the nuss repair, pectus excavatum using a sub-xiphoid incision, post-operative
video34:58 · Nov 2018
Pectus Deformities: Update Course 2015
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Dr. Whit Holcomb discusses pectus deformities. His presentation includes nickel allergy testing, how to avoid cardiac injury with the nuss repair, pectus excavatum using a sub-xiphoid incision, post-operative pain management, approach to po
video34:40 · Jan 2019
Pain Management: Pectus Innovations
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Dr. Senthilkumar Sadhasivam, Professor in the Department of Anesthesia, discusses pectus excavatum pain management. Dr. Sadhasivam covers topics on surgically-placed sub-cutaneous intercostal catheters, epidural placement, epidural infectio
video54:09 · Jan 2019
Minimally Invasive Repair of Pectus Carinatum
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This video appears in a new pediatric surgery textbook, Clinical Pediatric Surgery: A Case-Based Interactive Approach," by Dr. Sherif Emil. The book is an innovative educational resource that focuses on judgment and decision-making in pedia
video5:00 · Nov 2019
Minimally Invasive Repair of Pectus Carinatum
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This video appears in a new pediatric surgery textbook, Clinical Pediatric Surgery: A Case-Based Interactive Approach," by Dr. Sherif Emil. The book is an innovative educational resource that focuses on judgment and decision-making in pedia
video5:00 · Nov 2019
Evidence & Research
1 item
Journal of Pediatric Surgery Article Review: September 2023
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We’re featuring Journal of Pediatric surgery articles to bring you some of the latest news!
This week we are discussing 4 articles from September issue 2023, with editor Dr. Whit Holcomb and authors Drs. Sarah Abdellaoui and Charles Jaso
podcast13:31 · Mar 2024
In-Depth Reviews
3 items
An Update on Chest Wall Anomalies and Their Treatment: Advanced Practice...
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At the Advanced Practice Providers Pediatric Surgery Update Course in 2014, many distinguished advanced practice providers from around the world address the current evidence based management of the common pediatric surgical conditions. The
video46:05 · Sep 2018
Chest Wall Deformities with Dr. Robert Kelly
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Dr. Robert Kelly discuses chest wall deformities with Dr. Todd Ponsky. Edited by Ian C Glenn, MD and Nicholas Bruns, MD
podcast46:50 · Jan 2019
Chest Wall Deformities with Dr. Robert Kelly
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Dr. Robert Kelly discuses chest wall deformities with Dr. Todd Ponsky. Edited by Ian C Glenn, MD and Nicholas Bruns, MDPectus excavatumHistoryApproximately 2/3 of patients presenting with symptoms, which include dyspnea on exertion, easy fa
podcast46:50 · Dec 2020
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Every expert statement below comes from the recorded discussions, with its speaker and moment.
Chest Wall Deformities with Dr. Robert Kelly
Common presenting symptoms of pectus excavatum are easy fatigability with exertion, shortness of breath with exertion, and chest pain in the area of the pectus depression, generally occurring with exertion rather than at rest.
clinicalRobert Kelly1:33 ↗
Both Marfan syndrome and Ehlers-Danlos syndrome are conditions for which pectus excavatum is a marker.
clinicalRobert Kelly2:55 ↗
In patients with normal chest anatomy, ribs should move like the handle of a bucket (up and out) and the sternum should move like the handle of an old-fashioned water pump (towards the ceiling and out towards the examiner) during respiration.
clinicalRobert Kelly4:04 ↗
In pectus excavatum, the depressed area of the chest is frequently absolutely fixed or in younger patients may move paradoxically, with the xiphoid pulling back towards the spine when the patient takes a deep breath.
clinicalRobert Kelly4:29 ↗
In a series of more than 4000 patients evaluated for pectus excavatum, just over 25% had scoliosis.
epidemiologicalRobert Kelly6:15 ↗
When both severe scoliosis (past 40 or 50 degrees requiring spinal procedure) and pectus excavatum are present, the more clinically disruptive problem should be addressed first, in consultation with the orthopedic surgeon.
clinicalRobert Kelly6:36 ↗
In the multi-center study of pectus excavatum involving 11 centers, roughly two-thirds of patients had symptoms of easy fatigability, shortness of breath with exertion, or chest pain.
epidemiologicalRobert Kelly8:39 ↗
The Haller index is the ratio of the inner transverse diameter divided by the distance between the back of the sternum and the front of the spine. Haller reported in 1987 that an index greater than 3.25 indicates severe pectus.
clinicalRobert Kelly9:44 ↗
The Kansas City group recognized that in patients with a barrel chest, the Haller index underestimates the depth of depression because the AP diameter is increased. They advocate an alternative index comparing the depth at the depression to the depth more laterally, with more than 10% drop considered significant.
host_summaryRobert Kelly10:09 ↗
Mitral valve prolapse is present in about 14% of pectus excavatum patients in Dr. Kelly's series, compared to about 1% in young patients in the general population.
epidemiologicalRobert Kelly12:53 ↗
On average in a large number of pectus excavatum patients, pulmonary function tests are down by about one standard deviation from average (somewhere between 85 and 90% predicted).
epidemiologicalRobert Kelly13:37 ↗
In both Dr. Kelly's series and the multi-center study, patients came up by close to a standard deviation in pulmonary function when they had the bellows action of the chest restored by surgery.
clinicalRobert Kelly14:15 ↗
Restrictive lung disease (FVC less than 80% predicted with normal FEV1/FVC ratio) is present in a significant fraction of pectus excavatum patients and is corrected by pectus operation, unlike asthma which is not corrected.
clinicalRobert Kelly14:37 ↗
Patients with worse pectus excavatum have more likelihood of having restrictive pulmonary problems.
clinicalRobert Kelly15:05 ↗
Dr. Kelly's indications for pectus excavatum operation require at least 3 of 6 criteria: Haller index >3.2, pulmonary function tests decreased below 80% predicted, cardiac compression/mitral valve prolapse/other echo abnormalities, symptoms, progressive pectus, or major psychosocial issues related to body image.
guidelineRobert Kelly15:11 ↗
Around the time of the teenage growth spurt, there are many children in whom the pectus gets significantly deeper, and progressive deepening is considered a reason to intervene before it becomes more difficult to correct.
clinicalRobert Kelly15:35 ↗
The ideal age for pectus excavatum surgery is sometime just prior to the onset of puberty or early in puberty: in girls age 11 to 13, and in boys a year or two older than that.
clinicalRobert Kelly16:47 ↗
Having the bar in place during the rapid growth spurt of puberty results in extremely low likelihood of recurrence if the bar remains until that process is completed or nearly completed.
clinicalRobert Kelly17:02 ↗
Some Asian groups, particularly Dr. Park in Korea, operate on pectus excavatum patients when they are quite young (well under 10 years old) and report good results.
host_summaryRobert Kelly17:29 ↗
Dr. Kelly's center uses patient-controlled analgesia (PCA) pumps with a steady background dose of narcotic and ability to give booster doses, emphasizing the need to dial in the correct dose on the night of surgery based on patient feedback.
clinicalRobert Kelly18:49 ↗
Dr. Kelly's center has not used epidurals for pectus excavatum surgery for several years.
clinicalRobert Kelly19:39 ↗
Postoperative recommendations include spirometry hourly when awake, walking beginning the day after operation (emphasizing frequency over distance), eating small amounts (a couple hundred calories) every couple hours if appetite is reduced, and not rushing recovery.
clinicalRobert Kelly19:47 ↗
For the first month after pectus excavatum surgery, patients should only walk and perform activities of daily living. Beginning at 1 month they can liberalize physical activities, and by 3 to 6 months can do almost any activity except those where they know they will get a blow to the chest.
clinicalRobert Kelly20:46 ↗
The Allergies test developed in Canada includes all components of the stainless steel bar and is used for preoperative metal allergy screening. Patients who react (most commonly to nickel, but also chromium, cobalt, and other components) can receive a titanium bar, which must be bent at the factory and ordered in advance.
clinicalRobert Kelly21:37 ↗
Titanium bars are currently much more expensive than stainless steel bars. In an era of responsible cost containment, if stainless steel works well and costs less, it should be used when appropriate.
opinionRobert Kelly22:17 ↗
For Nuss procedure, thoracoscopy should be standard practice in patients with any difficulty in visualization, to ensure the tip of the introducer is seen at all times when passing from one side to the other.
guidelineRobert Kelly24:43 ↗
Sternal elevation techniques (vacuum bell, subxiphoid finger or bone hook, or Rultract device) are really important for Nuss procedure to improve visualization and make the path from one side to the other easier to identify.
clinicalRobert Kelly24:57 ↗
The most important part of the Nuss procedure is seeing the tip of the introducer at all times when passing from one side to the other. If this is done, the likelihood of injuring the heart is exceedingly low.
clinicalRobert Kelly26:02 ↗
To prevent bar displacement in Nuss procedure, Dr. Kelly favors using a tongue-in-groove stabilizer on one end of the bar and wrapping around the bar and adjacent rib with heavy absorbable suture (number 1 PDS), commonly putting 4 thicknesses around the intersection of bar and rib.
clinicalRobert Kelly26:43 ↗
For Nuss procedure incisions, measure from mid-axillary line to mid-axillary line and subtract an inch to determine bar length. Make 2-3 cm incisions more or less from anterior to mid-axillary line at the cephalocaudad level of the deepest point of the pectus.
clinicalRobert Kelly27:32 ↗
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