# Pectus Carinatum — GCMD Library living collection

Everything in the library about pectus carinatum — built automatically from dossiers that name it.

Updated: n/a · 13 episodes · 339 cited statements

## Episodes
### Fundamentals
- [Pectus Arcuatum a Pectus Unlike any Other](https://library.globalcastmd.com/watch/pectus-arcuatum-a-pectus-unlike-any-other-7899) — video · 0:51 · [machine version](https://library.globalcastmd.com/watch/pectus-arcuatum-a-pectus-unlike-any-other-7899.md)

### Diagnosis & Workup
- [Pectus - Preoperative Assessment - Genetics](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691) — video · 9:54 · [machine version](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691.md)
- [Pectus - Preoperative Assessment - Radiology and Cardiac Evaluation](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692) — video · 44:03 · [machine version](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692.md)
- [Genetics: Pectus Innovations](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018) — video · 9:48 · [machine version](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018.md)

### Surgical Management
- [Pectus Deformities: Update Course 2015](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671) — video · 34:58 · [machine version](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671.md)
- [Pectus Deformities: Update Course 2015](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990) — video · 34:40 · [machine version](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990.md)
- [Pain Management: Pectus Innovations](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015) — video · 54:09 · [machine version](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015.md)
- [Minimally Invasive Repair of Pectus Carinatum](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953) — video · 5:00 · [machine version](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953.md)
- [Minimally Invasive Repair of Pectus Carinatum](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954) — video · 5:00 · [machine version](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954.md)

### Evidence & Research
- [Journal of Pediatric Surgery Article Review: September 2023](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057) — podcast · 13:31 · [machine version](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057.md)

### In-Depth Reviews
- [An Update on Chest Wall Anomalies and Their Treatment: Advanced Practice...](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423) — video · 46:05 · [machine version](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423.md)
- [Chest Wall Deformities with Dr. Robert Kelly](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950) — podcast · 46:50 · [machine version](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950.md)
- [Chest Wall Deformities with Dr. Robert Kelly](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305) — podcast · 46:50 · [machine version](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305.md)

## Chapters
- [0:00](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=0) Introduction and Guest Presentation (Ep 11)
- [1:23](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=83) Patient Selection and Initial Evaluation for Pectus Excavatum (Ep 11)
- [7:20](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=440) Diagnostic Workup and Objective Criteria (Ep 11)
- [15:11](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=911) Surgical Indications and Optimal Timing (Ep 11)
- [16:47](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1007) Preoperative Counseling and Pain Management (Ep 11)
- [21:04](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1264) Nuss Procedure Technical Details (Ep 11)
- [27:23](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1643) Complications and Outcomes (Ep 11)
- [37:11](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2231) Non-operative Treatment: Vacuum Bell (Ep 11)
- [40:40](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2440) Pectus Carinatum Management (Ep 11)
- [45:15](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2715) Resources and Closing (Ep 11)
- [0:00](https://library.globalcastmd.com/watch/pectus-arcuatum-a-pectus-unlike-any-other-7899?t=0) Pectus Arcuatum: Diagnosis and Management (Ep 12)
- [0:00](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=0) Introduction and Pectus Arcuatum (Ep 13)
- [3:44](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=224) CDH Repair Timing on ECMO (Ep 13)
- [7:07](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=427) ERAS Protocols in Pediatric Colorectal Surgery (Ep 13)
- [8:46](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=526) Physician Suicide and Mental Health (Ep 13)
- [0:00](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=0) Marfan Syndrome Evaluation in Pectus Patients (Ep 3)
- [2:27](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=147) Ehlers-Danlos Syndrome Types: Classic, Vascular, and Hypermobile (Ep 3)
- [4:23](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=263) Beighton Score and Hypermobile EDS Criteria (Ep 3)
- [6:01](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=361) Clinical Constellation of Hypermobile EDS and Pain Risk (Ep 3)
- [8:28](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=508) Clinical Integration and Screening Practices (Ep 3)
- [0:00](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=0) Surgical Criteria for Pectus Excavatum Repair (Ep 2)
- [6:30](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=390) Nickel Allergy Screening and Infection Prevention (Ep 2)
- [11:10](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=670) Cardiac Injury Avoidance Techniques (Ep 2)
- [16:51](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1011) Postoperative Pain Management (Ep 2)
- [20:43](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1243) Complications: Infection and Rib Flaring (Ep 2)
- [23:51](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1431) Bar Duration and Outcomes (Ep 2)
- [27:16](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1636) Pectus Carinatum Management and Novel Techniques (Ep 2)
- [0:00](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=0) Introduction and Faculty Presentation (Ep 4)
- [4:26](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=266) Case Presentation: 13-Year-Old with Pectus Excavatum (Ep 4)
- [7:34](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=454) Radiology Assessment and MRI Protocol (Ep 4)
- [16:42](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=1002) Cardiac MRI Findings and Right Ventricular Function (Ep 4)
- [23:46](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=1426) Clinical Significance and Insurance Considerations (Ep 4)
- [30:58](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=1858) Audience Questions: Imaging Modalities and Decision-Making (Ep 4)
- [38:20](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=2300) Optimal Age for Repair and Radiation Risk (Ep 4)
- [0:06](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=6) Pectus Excavatum: Epidemiology, Pathophysiology, and Diagnostic Workup (Ep 1)
- [7:53](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=473) Surgical Indications and the Nuss Procedure (Ep 1)
- [13:21](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=801) Alternative and Emerging Therapies for Pectus Excavatum (Ep 1)
- [18:15](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=1095) Pectus Carinatum: Clinical Features and Bracing (Ep 1)
- [22:45](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=1365) Surgical Options for Pectus Carinatum (Ep 1)
- [27:34](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=1654) Rare Chest Wall Anomalies (Ep 1)

## Statements
Every statement is attributed, typed, and timestamped; the link is the citation.
- "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." — Robert Kelly (clinical) [Ep 11 · 1:33](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=93)
- "Both Marfan syndrome and Ehlers-Danlos syndrome are conditions for which pectus excavatum is a marker." — Robert Kelly (clinical) [Ep 11 · 2:55](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=175)
- "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." — Robert Kelly (clinical) [Ep 11 · 4:04](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=244)
- "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." — Robert Kelly (clinical) [Ep 11 · 4:29](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=269)
- "In a series of more than 4000 patients evaluated for pectus excavatum, just over 25% had scoliosis." — Robert Kelly (epidemiological) [Ep 11 · 6:15](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=375)
- "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." — Robert Kelly (clinical) [Ep 11 · 6:36](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=396)
- "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." — Robert Kelly (epidemiological) [Ep 11 · 8:39](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=519)
- "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." — Robert Kelly (clinical) [Ep 11 · 9:44](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=584)
- "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." — Robert Kelly (host_summary) [Ep 11 · 10:09](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=609)
- "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." — Robert Kelly (epidemiological) [Ep 11 · 12:53](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=773)
- "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)." — Robert Kelly (epidemiological) [Ep 11 · 13:37](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=817)
- "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." — Robert Kelly (clinical) [Ep 11 · 14:15](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=855)
- "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." — Robert Kelly (clinical) [Ep 11 · 14:37](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=877)
- "Patients with worse pectus excavatum have more likelihood of having restrictive pulmonary problems." — Robert Kelly (clinical) [Ep 11 · 15:05](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=905)
- "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." — Robert Kelly (guideline) [Ep 11 · 15:11](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=911)
- "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." — Robert Kelly (clinical) [Ep 11 · 15:35](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=935)
- "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." — Robert Kelly (clinical) [Ep 11 · 16:47](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1007)
- "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." — Robert Kelly (clinical) [Ep 11 · 17:02](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1022)
- "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." — Robert Kelly (host_summary) [Ep 11 · 17:29](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1049)
- "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." — Robert Kelly (clinical) [Ep 11 · 18:49](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1129)
- "Dr. Kelly's center has not used epidurals for pectus excavatum surgery for several years." — Robert Kelly (clinical) [Ep 11 · 19:39](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1179)
- "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." — Robert Kelly (clinical) [Ep 11 · 19:47](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1187)
- "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." — Robert Kelly (clinical) [Ep 11 · 20:46](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1246)
- "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." — Robert Kelly (clinical) [Ep 11 · 21:37](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1297)
- "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." — Robert Kelly (opinion) [Ep 11 · 22:17](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1337)
- "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." — Robert Kelly (guideline) [Ep 11 · 24:43](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1483)
- "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." — Robert Kelly (clinical) [Ep 11 · 24:57](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1497)
- "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." — Robert Kelly (clinical) [Ep 11 · 26:02](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1562)
- "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." — Robert Kelly (clinical) [Ep 11 · 26:43](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1603)
- "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." — Robert Kelly (clinical) [Ep 11 · 27:32](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1652)
- "In post-pubertal girls, making an incision where the breast meets the chest wall in a curved incision along the line of the breast gives excellent access and is a little more medial than the standard incision, which can be more convenient." — Robert Kelly (clinical) [Ep 11 · 27:39](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1659)
- "The bar should rest medial to the pectus ridge so there is a rib providing counterforce anteriorly on each side while the sternum pushes posteriorly. If placed very laterally, only intercostal muscles prevent movement and they will strip or rip under the load." — Robert Kelly (clinical) [Ep 11 · 28:54](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1734)
- "In growing patients, stabilizers on both sides of the bar can cause a wasp-waist effect when encased by scar, so Dr. Kelly generally favors putting stabilizers on only one side of the bar." — Robert Kelly (clinical) [Ep 11 · 30:07](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1807)
- "Patients over approximately 6 feet 2 inches tall have almost 100% chance of needing two bars for Nuss procedure. For shorter patients, the decision depends on how the sternum came up at operation." — Robert Kelly (clinical) [Ep 11 · 30:39](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1839)
- "The Chestwall International Group will be meeting June 15-17, 2016 in Norfolk, Virginia with participants from around the world presenting on various aspects of chest wall deformities." — Robert Kelly (clinical) [Ep 11 · 31:17](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1877)
- "Postoperatively for Nuss procedure, Dr. Kelly's center tries to wean patients off the PCA pump by stopping the basal rate on the second day and stopping the PCA altogether on the third day, so by the third day patients are on all oral medicines." — Robert Kelly (clinical) [Ep 11 · 32:02](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1922)
- "In multiple series of Nuss procedures, short-term complications are few and intervention has been infrequent." — Robert Kelly (host_summary) [Ep 11 · 33:03](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1983)
- "In Dr. Kelly's series of past 2000 Nuss procedures, about 2.7% of patients have required some sort of revision for bar displacement. This incidence has been cut to about half by using stabilizers and wrapping around the crossing of the bar to the rib with pericostal sutures." — Robert Kelly (epidemiological) [Ep 11 · 33:14](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=1994)
- "Most bar displacement in Dr. Kelly's current experience involves some kind of marked force, such as trauma from accidents." — Robert Kelly (clinical) [Ep 11 · 33:43](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2023)
- "Bar allergy occurred in a little less than 1% (0.9%) of patients. Since screening for metal allergy began in 2004, this has dramatically decreased the incidence. About 6.4% of patients had clinical or patch test evidence of metal allergy." — Robert Kelly (epidemiological) [Ep 11 · 34:13](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2053)
- "Wound infection occurred in 2.3% of patients in Dr. Kelly's series, with more than two-thirds being superficial or cellulitis. The center emphasizes skin preparation and perioperative antibiotics using an infection prevention bundle." — Robert Kelly (epidemiological) [Ep 11 · 34:40](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2080)
- "Recurrence after Nuss procedure occurred in about 1.2% of patients in Dr. Kelly's series. Why recurrence happens is still poorly understood, even when bars are left in for 3 years." — Robert Kelly (epidemiological) [Ep 11 · 35:07](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2107)
- "Dr. Kelly's center tries to see patients at 6 months after operation and then organize when bar removal will be. They favor removing the bar closer to 3 years than to 2 years, but it needs to be at least 2 years before removal." — Robert Kelly (clinical) [Ep 11 · 36:33](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2193)
- "The vacuum bell treatment for pectus excavatum was developed by Kloby in Germany. A recent paper from a hospital in Saint-Etienne, France published in Journal of Pediatric Surgery found it effective in eliminating pectus excavatum in 23 of 73 patients." — Robert Kelly (host_summary) [Ep 11 · 37:19](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2239)
- "Dr. Kelly's center has been using the vacuum bell for about 2 years and believes that in patients who are young (under about 10 years old), the vacuum bell can be very effective in lifting the chest up." — Robert Kelly (clinical) [Ep 11 · 37:49](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2269)
- "In patients with recurrent pectus excavatum following a previous Ravitch operation, a Nuss procedure can elevate the chest to some extent but won't restore chest wall movement, and patients will have some restrictive process from scarring. In some of these patients, a Ravitch operation may be beneficial." — Robert Kelly (clinical) [Ep 11 · 39:06](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2346)
- "Because brace therapy for pectus carinatum has been demonstrated to be successful in many places (somewhere between two-thirds and three-quarters of patients are cured), and any operation carries more morbidity than almost any brace, it is hard to justify not starting with brace treatment for most patients." — Robert Kelly (opinion) [Ep 11 · 40:04](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2404)
- "Dr. Kelly's center generally uses Marcello Ferro's dynamic compression system for pectus carinatum. The brace solved two patient objections: it is comfortable (pressure can be adjusted) and concealable (not visible under an opaque t-shirt). It works approximately three-quarters of the time in their hands." — Robert Kelly (clinical) [Ep 11 · 41:23](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2483)
- "Candidates for surgical treatment of pectus carinatum include patients who fail brace therapy, those with significant symptoms (pain and exercise limitation, though most carinatum patients do not have symptoms), and those whose chest is very stiff and not making progress with bracing." — Robert Kelly (clinical) [Ep 11 · 42:35](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2555)
- "The reverse Nuss operation (Abramson procedure) for pectus carinatum involves placing a bar in front of the sternum to pull it back. Dr. Kelly's center has used this operation since 2008 and it works well in patients with a flexible chest." — Robert Kelly (clinical) [Ep 11 · 43:13](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2593)
- "There is a broad perception among surgeons who have done many Ravitch operations for carinatum that there is an extremely low recurrence rate after that procedure, as opposed to the 10% recurrence rate after excavatum Ravitch." — Robert Kelly (host_summary) [Ep 11 · 43:43](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2623)
- "There is a family tendency for chest wall deformities in approximately 40% of patients, but the majority still don't have a family history." — Robert Kelly (epidemiological) [Ep 11 · 44:52](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-305?t=2692)
- "The study is a multi-center retrospective study conducted in France describing pectus arcuatum" — Cecilia Gigena (epidemiological) [Ep 12 · 0:11](https://library.globalcastmd.com/watch/pectus-arcuatum-a-pectus-unlike-any-other-7899?t=11)
- "The study included 34 patients with pectus arcuatum" — Cecilia Gigena (epidemiological) [Ep 12 · 0:20](https://library.globalcastmd.com/watch/pectus-arcuatum-a-pectus-unlike-any-other-7899?t=20)
- "47% of patients needed chest x-ray or CT scan to confirm the diagnosis of pectus arcuatum" — Cecilia Gigena (clinical) [Ep 12 · 0:20](https://library.globalcastmd.com/watch/pectus-arcuatum-a-pectus-unlike-any-other-7899?t=20)
- "35% of pectus arcuatum patients were associated with a malformation" — Cecilia Gigena (epidemiological) [Ep 12 · 0:29](https://library.globalcastmd.com/watch/pectus-arcuatum-a-pectus-unlike-any-other-7899?t=29)
- "Noonan syndrome is an associated malformation seen with pectus arcuatum" — Cecilia Gigena (clinical) [Ep 12 · 0:29](https://library.globalcastmd.com/watch/pectus-arcuatum-a-pectus-unlike-any-other-7899?t=29)
- "Scoliosis is an associated malformation seen with pectus arcuatum" — Cecilia Gigena (clinical) [Ep 12 · 0:29](https://library.globalcastmd.com/watch/pectus-arcuatum-a-pectus-unlike-any-other-7899?t=29)
- "The best treatment for pectus arcuatum was surgical correction that included a sternotomy" — Cecilia Gigena (clinical) [Ep 12 · 0:29](https://library.globalcastmd.com/watch/pectus-arcuatum-a-pectus-unlike-any-other-7899?t=29)
- "Pectus arcuatum should not be confused with pectus carinatum as they are different conditions" — Cecilia Gigena (clinical) [Ep 12 · 0:41](https://library.globalcastmd.com/watch/pectus-arcuatum-a-pectus-unlike-any-other-7899?t=41)
- "Pectus arcuatum is a bony deformity caused by a premature obliteration of the sternal sutures, resulting in a short sternum bent on itself" — Sahab Delaville (clinical) [Ep 13 · 2:07](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=127)
- "47% of pectus arcuatum patients required X-ray or CT scan for diagnosis" — Cecilia Gigena (clinical) [Ep 13 · 1:56](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=116)
- "35% of pectus arcuatum cases had associated malformations like Noonan syndrome, scoliosis, or cardiopathy" — Sahab Delaville (epidemiological) [Ep 13 · 2:40](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=160)
- "25% of pectus arcuatum patients had skeletal malformation in their family" — Sahab Delaville (epidemiological) [Ep 13 · 2:55](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=175)
- "Bracing does not work for pectus arcuatum treatment" — Sahab Delaville (clinical) [Ep 13 · 3:02](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=182)
- "Pectus arcuatum treatment requires surgery that includes a sternotomy" — Cecilia Gigena (clinical) [Ep 13 · 3:07](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=187)
- "Patients diagnosed with pectus arcuatum need cardiac ultrasound to look for cardiac malformation and evaluation for scoliosis" — Sahab Delaville (guideline) [Ep 13 · 3:13](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=193)
- "Early CDH repair on ECMO was defined as during the first 48 hours after ECMO cannulation" — Red Holcomb (clinical) [Ep 13 · 4:40](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=280)
- "Bleeding risk for CDH repair on ECMO was approximately 1% if operated in less than 24 hours" — Jason Smithers (clinical) [Ep 13 · 4:58](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=298)
- "Bleeding risk for CDH repair on ECMO was 5-6% at 48 hours" — Jason Smithers (clinical) [Ep 13 · 5:08](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=308)
- "Bleeding risk for CDH repair on ECMO jumped to approximately 15% after 48 hours" — Jason Smithers (clinical) [Ep 13 · 5:11](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=311)
- "Duration of ECMO support was shorter in the early CDH repair group" — Em Gootee (host_summary) [Ep 13 · 5:17](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=317)
- "Survival was not statistically different between early and delayed CDH repair groups on ECMO" — Em Gootee (host_summary) [Ep 13 · 5:17](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=317)
- "Some patients who only get CDH repair off ECMO die because they never came off ECMO" — Jason Smithers (clinical) [Ep 13 · 6:46](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=406)
- "The key after CDH repair is to get lung growth in such a way that the contralateral lung grows the most and not the ipsilateral lung" — Jason Smithers (clinical) [Ep 13 · 6:53](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=413)
- "ERAS protocols significantly reduce intraoperative fluids needed by pediatric colorectal surgery patients" — Cecilia Gigena (clinical) [Ep 13 · 7:41](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=461)
- "ERAS protocols significantly reduce postoperative opiate use in pediatric colorectal surgery" — Cecilia Gigena (clinical) [Ep 13 · 7:41](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=461)
- "Time to first oral intake was less in pediatric colorectal surgery patients with ERAS protocols" — Cecilia Gigena (clinical) [Ep 13 · 7:55](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=475)
- "Time for complete nutrition was less in pediatric colorectal surgery patients with ERAS protocols" — Cecilia Gigena (clinical) [Ep 13 · 7:55](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=475)
- "ERAS protocols have a beneficial role in accelerating rehabilitation and shortening length of hospitalization" — Red Holcomb (clinical) [Ep 13 · 8:13](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=493)
- "Physician suicide is characterized by tragically high rates of suicide among doctors compared to the general population" — Em Gootee (host_summary) [Ep 13 · 9:32](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=572)
- "Every surgeon will have adversity in practice with patients where despite best efforts there is not a good result" — Red Holcomb (opinion) [Ep 13 · 9:47](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=587)
- "High levels of stress, emotional and physical burnout, demanding work schedules, and pressure to maintain successful careers contribute to physician suicide" — Em Gootee (host_summary) [Ep 13 · 10:17](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=617)
- "Stigma associated with mental health issues within the medical profession discourages physicians from seeking help, leading to untreated depression, anxiety, and other mental health disorders" — Em Gootee (host_summary) [Ep 13 · 10:33](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=633)
- "Physician mental health and suicide is discussed more now versus 10 years ago, but still should be discussed more openly" — Red Holcomb (opinion) [Ep 13 · 11:30](https://library.globalcastmd.com/watch/journal-of-pediatric-surgery-article-review-september-2023-8057?t=690)
- "In pectus excavatum clinic, skeletal evaluation for Marfan syndrome includes examination for wrist sign (thumb and pinky finger overlap when wrapped around wrist) and thumb protrusion past the ulnar border to evaluate for long bone overgrowth relative to trunk." (clinical) [Ep 3 · 0:21](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=21)
- "Arm span to height ratios and upper to lower segment ratios are evaluated as part of Marfan syndrome skeletal assessment." (clinical) [Ep 3 · 1:00](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=60)
- "Skeletal findings evaluated for Marfan syndrome include pectus excavatum, pectus carinatum, scoliosis, and hind foot deformities." (clinical) [Ep 3 · 1:07](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=67)
- "The cardiac risk associated with Marfan syndrome includes aortic dissection and mitral valve prolapse, as well as retinal detachments." (clinical) [Ep 3 · 1:19](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=79)
- "Diagnosis of Marfan syndrome is largely centered on cardiac findings, with echocardiogram or MRI as main tools to evaluate for dilated aortic root." (clinical) [Ep 3 · 1:38](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=98)
- "Lens dislocations are evaluated as part of Marfan syndrome assessment, and fibrillin gene testing is performed in cases with suggestive findings." (clinical) [Ep 3 · 1:55](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=115)
- "In patients with Marfan-like characteristics, evaluation may be extended to other genetic syndromes involving TGF beta signaling, which is implicated in aortic remodeling and long bone overgrowth." (clinical) [Ep 3 · 2:05](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=125)
- "Ehlers-Danlos syndrome is by far the more common condition evaluated in pectus patients compared to Marfan syndrome." (epidemiological) [Ep 3 · 2:27](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=147)
- "Ehlers-Danlos syndrome represents a grouping of related conditions affecting connective tissue, not a single condition." (clinical) [Ep 3 · 2:45](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=165)
- "Classic type Ehlers-Danlos is due to defects in collagen 5 and is characterized by joint hypermobility and abnormal skin that is fragile, thin, with weak and papery thin scars." (clinical) [Ep 3 · 3:00](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=180)
- "Vascular type Ehlers-Danlos is caused by mutations in collagen 3 and is characterized by internal organ fragility rather than hypermobile joints." (clinical) [Ep 3 · 3:17](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=197)
- "Vascular Ehlers-Danlos is one of the least common conditions seen in pectus clinic." (epidemiological) [Ep 3 · 3:39](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=219)
- "For vascular Ehlers-Danlos, screening looks for family history or personal history of ruptures (bowel, aortic, or uterine rupture)." (clinical) [Ep 3 · 3:52](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=232)
- "Genetic testing for vascular Ehlers-Danlos is 99% sensitive." (clinical) [Ep 3 · 4:07](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=247)
- "The hypermobile type of Ehlers-Danlos is what is typically evaluated in pectus clinic, characterized by very flexible patients." (clinical) [Ep 3 · 4:23](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=263)
- "The Beighton score is a test of 9 different joints, scored 1 for each side except the hips, used to formally assess hypermobility." (clinical) [Ep 3 · 4:41](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=281)
- "Beighton score criteria include: hyperextension of arms past 10 degrees, hyperextension of pinky past 90 degrees, apposition of thumb to forearm, hyperextension of knee past 10 degrees (all scored bilaterally for 8 points), and placing hands flat on floor without bending knees (assessing hip hypermobility)." (clinical) [Ep 3 · 4:52](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=292)
- "Five or more hypermobile joints on the Beighton score meets criteria for generalized hypermobility." (clinical) [Ep 3 · 5:27](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=327)
- "Additional findings evaluated for hypermobile Ehlers-Danlos include mild skin changes (mild hyperextensibility, easy bruising, scarring abnormalities, striae) and family history of hypermobility." (clinical) [Ep 3 · 5:35](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=335)
- "The dividing line between being flexible and having Ehlers-Danlos may be very fuzzy; diagnosis looks for similar findings in family members and presence of clinical problems." (opinion) [Ep 3 · 6:01](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=361)
- "Clinical problems associated with hypermobile Ehlers-Danlos include: loose joints that dislocate, chronic pain, chronic headaches and migraines, temporomandibular joint dysfunction, easy bruising and bleeding, orthostatic hypotension or dizziness with standing, episodes of racing heartbeat, chronic constipation with irritable bowel syndrome, panic and anxiety disorders, and sleeping problems." (clinical) [Ep 3 · 6:25](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=385)
- "Most adult patients with hypermobile Ehlers-Danlos have almost all of the associated problems (pain, headaches, TMJ, bleeding, orthostatic issues, IBS, anxiety, sleep problems)." (epidemiological) [Ep 3 · 7:12](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=432)
- "In children with hypermobile Ehlers-Danlos, problems may be very mild or not evident, but may begin to emerge during puberty, which may coincide with when they consider pectus surgery." (clinical) [Ep 3 · 7:17](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=437)
- "The chronic pain aspect of hypermobile Ehlers-Danlos can affect whether patients are at risk for more pain from pectus surgery." (clinical) [Ep 3 · 7:33](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=453)
- "Hypermobility is a risk factor for fibromyalgia; 50% of teenagers diagnosed with fibromyalgia have hypermobility." (epidemiological) [Ep 3 · 7:42](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=462)
- "Fibromyalgia involves central sensitivity to pain, meaning patients are unable to filter out unwanted pain signals in the same way as other persons." (clinical) [Ep 3 · 7:56](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=476)
- "A hypermobile patient may be at risk for having more problems with chronic pain due to central pain sensitivity mechanisms." (clinical) [Ep 3 · 8:08](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=488)
- "One clinician's screening approach for pectus patients includes checking for double-jointedness, appearance of Marfan disease, arachnodactyly, and striae, with referral to genetics if findings are present." (clinical) [Ep 3 · 8:41](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-genetics-691?t=521)
- "Haller index of 3.25 originated from a retrospective study by Alec Haller in the 1980s comparing cases he fixed versus those he did not" — Holcomb (clinical) [Ep 2 · 4:33](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=273)
- "The Haller index study was not an earth-shattering study at the time but has been used consistently for 30 years" — Holcomb (opinion) [Ep 2 · 5:10](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=310)
- "Psychosocial aspects of growing up are very important, and severe deformities should be fixed for psychosocial well-being regardless of symptoms" — Holcomb (opinion) [Ep 2 · 1:59](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=119)
- "Insurance companies require documented symptoms and a Haller index for approval of pectus repair" (guideline) [Ep 2 · 2:13](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=133)
- "Nickel allergy frequency in pectus patients is 2.8% (almost 3%) according to Doctor Nuss's group study of 1200 patients from 1987-2008" — Holcomb (host_summary) [Ep 2 · 24:18](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1458)
- "In a randomized trial of 110 patients, epidural catheters were removed within 24 hours or could not be placed in almost 25% of cases, even by experienced anesthesiologists" — Holcomb (host_summary) [Ep 2 · 18:18](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1098)
- "Epidural group had longer OR time due to catheter placement, more phone calls to anesthesia, and greater hospital charges compared to PCA" — Holcomb (host_summary) [Ep 2 · 17:44](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1064)
- "Pain scores generally favored epidural for the first 2 days, were flat on day 3, and favored PCA in the last couple of days" — Holcomb (host_summary) [Ep 2 · 18:04](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1084)
- "In Kansas City series of 168 patients over 6 years, there were 6 infections (3.6%), 5 required incision and drainage, 3 developed recurrent infections, and 1 required early bar removal" — Holcomb (clinical) [Ep 2 · 19:56](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1196)
- "Doctor Nuss feels results are better if bars are left in for 3 years based on his group's data showing improved outcomes with duration ≥24 months" — Holcomb (host_summary) [Ep 2 · 25:03](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1503)
- "Kansas City has performed 503 pectus excavatum repairs using subxiphoid incision technique with no cardiac injuries" — Holcomb (clinical) [Ep 2 · 25:36](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1536)
- "In Kansas City series of first 300 cases: 5% required two bars, 4% infection rate, 1.5% bar dislodgement or stabilizer discomfort requiring removal, 4 patients had bar rotation (early experience), 2 patients required chest tube, zero recurrences requiring reoperation, mean hospitalization 4 days" — Holcomb (clinical) [Ep 2 · 25:46](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1546)
- "There are approximately 14-15 reported cases of cardiac injury with the Nuss procedure worldwide" — Holcomb (epidemiological) [Ep 2 · 11:13](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=673)
- "Thoracoscopy is not that helpful for cardiac injury prevention according to Kansas City's experience, so they do not generally use it" — Holcomb (opinion) [Ep 2 · 13:06](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=786)
- "The subxiphoid incision technique involves making a small incision to insert a finger, removing the xiphoid process, lifting the sternum with a retractor, and feeling/guiding the bar as it passes above the heart" — Holcomb (clinical) [Ep 2 · 13:28](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=808)
- "For pectus carinatum, dynamic compression bracing requires less than 7.5 PSI pressure to correct the defect for appropriate candidacy" — Holcomb (clinical) [Ep 2 · 30:08](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1808)
- "Pectus carinatum bracing is typically worn 6-20 months, then transitioned to retainer mode (6-12 hours daily)" — Holcomb (clinical) [Ep 2 · 30:49](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1849)
- "Kansas City has braced 200 pectus carinatum patients with dynamic compression bracing and has performed very few (one or two) open repairs in the past 4 years" — Holcomb (clinical) [Ep 2 · 33:17](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1997)
- "The dynamic compression brace costs approximately $1500-2000 total, requiring purchase of both a kit (one-time) and the device" — Holcomb (clinical) [Ep 2 · 33:46](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=2026)
- "Transesophageal echo can be used to detect adhesions between heart and sternum, particularly useful in redo cases to avoid cardiac injury" (clinical) [Ep 2 · 15:29](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=929)
- "A bone hook can be used through the subxiphoid incision to lift the sternum and gain an additional 1-2 millimeters of space for bar passage in deep deformities" (clinical) [Ep 2 · 15:54](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=954)
- "Currarino-Silverman syndrome shows a comma deformity on lateral X-ray and requires open Ravitch-type repair" — Holcomb (clinical) [Ep 2 · 31:29](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1889)
- "Doctor Abramson in Buenos Aires has devised a minimally invasive operation for pectus carinatum" — Holcomb (host_summary) [Ep 2 · 31:53](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1913)
- "The magnetic mini-mover procedure (3MP) is in an FDA trial, 18 months into enrollment with all patients implanted, requiring another 18 months of data collection" — Holcomb (host_summary) [Ep 2 · 27:29](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=1649)
- "A vacuum cup suction device is being used in Europe for pectus repair but is not approved in the United States" — Holcomb (clinical) [Ep 2 · 16:27](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-671?t=987)
- "Pectus excavatum repair is arguably the most painful operation that could be done in a child." — Victor Garcia (clinical) [Ep 4 · 2:48](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=168)
- "Approximately 15% of pectus patients had right ventricular ejection fractions less than 50% (normal is 50%)." — Michael Taylor (epidemiological) [Ep 4 · 21:34](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=1294)
- "Patients with RV compression had depressed right ventricular ejection fractions, particularly when compression affected the free wall versus the groove between right atrium and right ventricle." — Michael Taylor (clinical) [Ep 4 · 23:25](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=1405)
- "Haller found that patients with a Haller index greater than 3.25 were ones he operated on, but this was an observational retrospective study, not a rigorous scientific or prospective study." — Eric Crotty (clinical) [Ep 4 · 11:55](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=715)
- "There is a very large overlap between patients with normal chests and patients with pectus excavatum regarding Haller indices—normal patients can have technically abnormal Haller index without pectus, and vice versa." — Eric Crotty (clinical) [Ep 4 · 13:11](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=791)
- "The correction index (greater than 10%) shows no overlap between normal and abnormal patients, unlike the Haller index." — Eric Crotty (clinical) [Ep 4 · 13:38](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=818)
- "The depression index (greater than 0.2) accounts for variable chest shapes (barrel-shaped versus elliptical) and should be abnormal in pectus excavatum regardless of chest configuration." — Eric Crotty (clinical) [Ep 4 · 14:02](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=842)
- "Depending on the phase of respiration, the Haller index can change—some patients have abnormal indices at end expiration but normal indices at end inspiration despite clinical pectus excavatum." — Eric Crotty (clinical) [Ep 4 · 10:26](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=626)
- "Cardiac MRI can replace CT and echocardiogram, providing anatomical and functional evaluation without contrast in approximately 25 minutes." — Michael Taylor (clinical) [Ep 4 · 16:42](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=1002)
- "Echocardiogram image quality in most pectus patients is atrocious—you can't see much of anything because the right ventricle and sternum are in the very near field of the transducer." — Michael Taylor (clinical) [Ep 4 · 18:40](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=1120)
- "Cardiac MRI allows screening for valve disease and aortopathy, both part of the connective tissue spectrum, in addition to assessing pectus anatomy and cardiac function." — Michael Taylor (clinical) [Ep 4 · 17:38](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=1058)
- "Kids can have right ventricular ejection fractions in the 40s and be asymptomatic; symptoms often don't manifest until very late in the disease process." — Michael Taylor (clinical) [Ep 4 · 24:31](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=1471)
- "As kids with pectus age, the heart appears to get extruded into the left chest, though whether this is a growth developmental phenomenon is unknown." — Michael Taylor (clinical) [Ep 4 · 26:29](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=1589)
- "A standard CT dose for pectus can deliver about 7 millisieverts of radiation, equivalent to about 2 years of background radiation in one scan." — Eric Crotty (clinical) [Ep 4 · 40:14](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=2414)
- "The earlier you get a CT and the higher the dose, the greater your long-term risk of developing malignancy; pediatric tissues divide more rapidly and have more time to develop DNA breaks." — Eric Crotty (clinical) [Ep 4 · 39:29](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=2369)
- "There is data suggesting an increased risk of malignancy long term from even one CT, and the younger you are, that risk increases over your lifetime." — Eric Crotty (epidemiological) [Ep 4 · 41:13](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=2473)
- "Children tolerate MRI very well; video goggle technology allows them to watch movies during the procedure, relieving anxiety." — Eric Crotty (clinical) [Ep 4 · 28:18](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=1698)
- "MRI can be performed with pectus bars in place; there may be small localized susceptibility artifacts where the bar is on top of the heart, but they are minimal." — Michael Taylor (clinical) [Ep 4 · 29:09](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=1749)
- "Insurance companies require some metric (abnormal pectus index plus evidence of cardiac dysfunction or abnormality) to approve coverage; providing multiple indices (Haller, correction, depression) plus cardiac dysfunction evidence has been effective in reversing denials." — Victor Garcia (guideline) [Ep 4 · 31:08](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=1868)
- "Dr. Park in Korea, who performs the largest number of pectus repairs worldwide, argues that age 3 and older is safe for repair, and earlier is better." — Victor Garcia (host_summary) [Ep 4 · 42:03](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=2523)
- "When operating on younger patients, bars need to be shorter (not extending to mid-axillary line) to avoid impeding chest wall growth." — Victor Garcia (clinical) [Ep 4 · 42:31](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=2551)
- "Overcorrection from excavatum to carinatum can occur if repair is done too early, particularly in patients with connective tissue disorders (reported by Hopkins group)." — Victor Garcia (host_summary) [Ep 4 · 43:01](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=2581)
- "Dr. Park reports seeing fewer asymmetric pectus patients because he corrects them when they're younger, suggesting early correction may prevent asymmetry development." — Victor Garcia (host_summary) [Ep 4 · 43:35](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=2615)
- "The Cincinnati Children's approach is selective in identifying patients who will benefit from surgery and emphasizes helping patients and parents deal with pain and discomfort, minimizing workup risks (ionizing radiation), and mitigating chronic pain and substance abuse risk." — Victor Garcia (clinical) [Ep 4 · 2:48](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=168)
- "Standard preoperative workup includes cardiac MRI, genetics referral for connective tissue evaluation, and allergy testing (particularly for nickel and vanadium in bar materials)." — Becky Brown (guideline) [Ep 4 · 6:15](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=375)
- "Patients with connective tissue disorders and hyperflexibility may be at higher risk for chronic pain after pectus repair." — Becky Brown (clinical) [Ep 4 · 6:32](https://library.globalcastmd.com/watch/pectus-preoperative-assessment-radiology-and-cardiac-evaluation-692?t=392)
- "Pectus excavatum is the most common chest wall deformity, though Argentina reports carinatum as more common in their country." (epidemiological) [Ep 1 · 2:19](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=139)
- "Pectus excavatum is rarely seen in African Americans." (epidemiological) [Ep 1 · 2:31](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=151)
- "Pectus excavatum is more often in males than females and statistically appears more common in tall, thin white boys." (epidemiological) [Ep 1 · 2:57](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=177)
- "Females with pectus have a slightly increased risk of mild scoliosis, occurring in 18% of those with pectus." (epidemiological) [Ep 1 · 3:11](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=191)
- "Many patients with pectus have a connective tissue disorder higher than in the normal population, such as Marfan syndrome and Ehlers-Danlos syndrome." (clinical) [Ep 1 · 3:26](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=206)
- "Studies show varying degrees of cardiac and pulmonary compromise in pectus excavatum, which seems to worsen as patients grow and their chest wall becomes less compliant." (clinical) [Ep 1 · 4:08](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=248)
- "Patients with deep pectus defects can have decreased cardiac output due to heart displacement, causing them to tire quicker than peers during exercise." (clinical) [Ep 1 · 4:22](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=262)
- "Pulmonary effects can include restrictive lung disease pattern and atelectasis if the chest is sufficiently restricted." (clinical) [Ep 1 · 4:43](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=283)
- "In Maryland, insurance typically covers pectus repair if the Haller index (pectus index) is greater than 3.25." (guideline) [Ep 1 · 5:12](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=312)
- "Johns Hopkins developed a pectus excavatum CT protocol using a flash scan with fewer cuts at deeper depth to reduce radiation exposure." (clinical) [Ep 1 · 6:17](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=377)
- "PA and lateral chest X-ray can be used to accurately measure pectus severity index without CT scan." (clinical) [Ep 1 · 6:58](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=418)
- "Some patients with severe psychological symptoms from pectus may not be satisfied with surgical outcomes even when the chest result is objectively good." (opinion) [Ep 1 · 8:50](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=530)
- "Dr. Nuss from King's Daughters Children's Hospital in Virginia began the minimally invasive pectus repair operation in 1988, placing a stainless steel rod underneath the chest wall." (clinical) [Ep 1 · 11:36](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=696)
- "The Nuss bar is usually kept in place for 2 to 3 years." (clinical) [Ep 1 · 12:24](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=744)
- "At Johns Hopkins, bars are left in closer to 3 years because longer duration decreases recurrence rate, especially in younger patients who may have significant growth spurts." (clinical) [Ep 1 · 12:37](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=757)
- "The average age for pectus excavatum surgery is about 14 years." (clinical) [Ep 1 · 12:56](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=776)
- "Vacuum bell therapy involves wearing a device for several hours a day to pull up the sternum, likely requiring a younger patient with compliant chest wall." (clinical) [Ep 1 · 13:42](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=822)
- "Dr. Nuss and colleagues in Virginia use the vacuum bell intraoperatively to elevate deep pectus defects and facilitate safer bar passage." (clinical) [Ep 1 · 14:23](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=863)
- "UCSF and Shriners are conducting the Magnetic Mini Mover trial for pectus excavatum in 8-14 year olds, using internal and external magnets to create a force field over several months to elevate the chest." (clinical) [Ep 1 · 15:48](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=948)
- "Diana Farmer reported that the magnetic therapy is quite effective based on preliminary results." (host_summary) [Ep 1 · 17:01](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=1021)
- "At Johns Hopkins, combined cardiac and pectus repair is performed simultaneously by pediatric and cardiac surgeons in patients with Marfan syndrome and cardiac issues, avoiding two separate surgeries." (clinical) [Ep 1 · 18:28](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=1108)
- "Pectus carinatum patients may complain of tenderness at the protrusion, especially if they play sports with pads or sleep on their stomach." (clinical) [Ep 1 · 19:34](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=1174)
- "Bracing has become the standard of care for pectus carinatum, with minimal postoperative problems and rare recurrence when surgery is performed." (clinical) [Ep 1 · 20:02](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=1202)
- "Pectus carinatum braces are typically worn 23 hours a day initially, then weaned to nighttime only, for about 9-12 months total." (clinical) [Ep 1 · 21:52](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=1312)
- "The dynamic compression device from Argentina (Marcelo Martinez Ferro's brace) is emerging as the best brace for pectus carinatum, with pressure measurement and time sensing capabilities." (opinion) [Ep 1 · 23:04](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=1384)
- "Physical therapist application of pectus carinatum braces, with chest massage and manual defect reduction before tightening, results in better compliance and outcomes compared to orthotist application." (clinical) [Ep 1 · 25:45](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=1545)
- "The Abramson technique (reverse Nuss) for pectus carinatum places a bar over the sternum, but wire erosion through bone has been reported due to the compressive force." (clinical) [Ep 1 · 26:35](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=1595)
- "Poland syndrome patients with underdeveloped fingers or syndactyly are referred to plastic surgery at a young age for early intervention." (clinical) [Ep 1 · 29:18](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=1758)
- "For Poland syndrome chest wall reconstruction, plastic surgery waits until patients are nearly done growing and uses flap techniques similar to post-mastectomy reconstruction." (clinical) [Ep 1 · 29:41](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=1781)
- "Pain from the Nuss repair is reportedly greater than the Ravitch repair despite smaller incisions." (clinical) [Ep 1 · 31:17](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=1877)
- "At Johns Hopkins, PCA provides better pain control than epidurals for pectus patients, and epidurals delayed early ambulation." (clinical) [Ep 1 · 31:39](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=1899)
- "Pectus excavatum patients at Johns Hopkins do not receive Foley catheters and ambulate to the bathroom the night of surgery." (clinical) [Ep 1 · 32:00](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=1920)
- "Typical hospital discharge after Nuss procedure is by postoperative day 3 or 4." (clinical) [Ep 1 · 32:33](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=1953)
- "Patients are transitioned from PCA to oral oxycodone the day after surgery if eating well." (clinical) [Ep 1 · 32:52](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=1972)
- "Haller index greater than 3.25 is the threshold for insurance coverage of pectus repair at Johns Hopkins." (guideline) [Ep 1 · 35:19](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=2119)
- "Patients in better physical condition who play sports and do upper body work recover faster from pectus surgery." (clinical) [Ep 1 · 36:11](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=2171)
- "The Nuss procedure typically takes about one hour of operative time." (clinical) [Ep 1 · 36:48](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=2208)
- "Intraoperative antibiotics are given but not continued postoperatively for pectus repair." (clinical) [Ep 1 · 37:07](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=2227)
- "Patients are allowed to position themselves however comfortable after Nuss repair, with no strict positioning restrictions." (clinical) [Ep 1 · 37:16](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=2236)
- "Activity restrictions after Nuss repair include no heavy lifting greater than 10 pounds for 6 weeks and no contact sports during that period." (clinical) [Ep 1 · 39:05](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=2345)
- "Valium is added to oxycodone for postoperative pain management to help with anxiety and muscle spasms in the back from posture changes." (clinical) [Ep 1 · 39:39](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=2379)
- "Most pectus patients are off narcotic pain medication between 2 and 4 weeks postoperatively." (clinical) [Ep 1 · 42:20](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=2540)
- "Compliance rate with pectus carinatum bracing is approximately 85%." (clinical) [Ep 1 · 45:12](https://library.globalcastmd.com/watch/an-update-on-chest-wall-anomalies-and-their-treatment-advanced-practice-423?t=2712)
- "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 not occurring at rest but with exertion." — Robert Kelly (clinical) [Ep 5 · 1:33](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=93)
- "Both Marfan syndrome and Ehlers-Danlos syndrome are conditions for which pectus excavatum is a marker." — Robert Kelly (clinical) [Ep 5 · 2:55](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=175)
- "In a normal chest, 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)." — Robert Kelly (clinical) [Ep 5 · 4:04](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=244)
- "In pectus excavatum, the depressed area of the chest is frequently absolutely fixed or in younger patients may move paradoxically, so that when the patient takes in a deep breath the xyphoid pulls back towards the spine." — Robert Kelly (clinical) [Ep 5 · 4:29](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=269)
- "In a series of more than 4000 patients evaluated for pectus excavatum, just over 25% had scoliosis." — Robert Kelly (epidemiological) [Ep 5 · 6:05](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=365)
- "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." — Robert Kelly (clinical) [Ep 5 · 6:36](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=396)
- "In the multi-center study of pectus excavatum at 11 centers, roughly 2/3 of patients had symptoms of easy fatigability, shortness of breath, or chest pain." — Robert Kelly (epidemiological) [Ep 5 · 8:39](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=519)
- "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; an index greater than 3.25 indicates severe pectus excavatum." — Robert Kelly (clinical) [Ep 5 · 9:44](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=584)
- "The Kansas City group recognized that in a patient with a barrel chest, the Haller index underestimates the depth of the depression because the AP diameter is increased, and they advocate an alternative index comparing the AP distance at the depression to the normal lateral chest." — Robert Kelly (clinical) [Ep 5 · 10:09](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=609)
- "Mitral valve prolapse is present in about 14% of pectus excavatum patients, compared to about 1% in young patients generally." — Robert Kelly (epidemiological) [Ep 5 · 12:53](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=773)
- "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)." — Robert Kelly (epidemiological) [Ep 5 · 13:37](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=817)
- "Patients with pectus excavatum came up by close to a standard deviation in pulmonary function when they had the bellows action of the chest restored through surgery." — Robert Kelly (clinical) [Ep 5 · 14:15](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=855)
- "Restrictive lung disease (FVC less than 80% predicted with normal FEV1/FVC ratio) is seen in a significant fraction of pectus excavatum patients and is corrected by pectus operation, unlike asthma which is not corrected." — Robert Kelly (clinical) [Ep 5 · 14:37](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=877)
- "Patients with worse pectus excavatum have more likelihood of having restrictive pulmonary problems." — Robert Kelly (clinical) [Ep 5 · 15:05](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=905)
- "Surgical indications for pectus excavatum include at least 3 of 6 criteria: Haller index >3.2, pulmonary function tests <80% predicted, cardiac compression/mitral valve prolapse/other echo abnormalities, symptoms, progressive pectus, and major psychosocial issues related to body image." — Robert Kelly (guideline) [Ep 5 · 15:11](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=911)
- "The ideal age for pectus excavatum surgery is sometime just prior to the onset of puberty or early in puberty (ages 11-13 for girls, a year or two older for boys)." — Robert Kelly (clinical) [Ep 5 · 16:47](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=1007)
- "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." — Robert Kelly (clinical) [Ep 5 · 17:02](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=1022)
- "Some Asian groups, particularly in Korea (Dr. Park), operate on pectus excavatum patients when they are quite young (well under 10 years old) and report good results." — Robert Kelly (clinical) [Ep 5 · 17:29](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=1049)
- "The hard part of pain management is not to relieve the pain, but to relieve the pain without obliterating consciousness, which requires feedback from the patient." — Robert Kelly (clinical) [Ep 5 · 18:32](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=1112)
- "About half of pectus excavatum patients don't have their usual appetite after surgery, while about half eat very well." — Robert Kelly (clinical) [Ep 5 · 20:03](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=1203)
- "For the first month after pectus excavatum surgery, patients should only walk and do activities of daily life; beginning at 1 month they can liberalize physical activities; by 3-6 months they can do pretty much any activity except those where they know they'll get a blow to the chest." — Robert Kelly (guideline) [Ep 5 · 20:46](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=1246)
- "The Allergies test developed in Canada includes all components of the stainless steel bar, and patients have reacted against a number of minor components including nickel, chromium, and cobalt." — Robert Kelly (clinical) [Ep 5 · 21:40](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=1300)
- "Titanium bars must be bent at the factory and have to be ordered in advance; they are currently much more expensive than stainless steel bars." — Robert Kelly (clinical) [Ep 5 · 22:17](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=1337)
- "The likelihood of transfusion in Nuss procedure is exceedingly low." — Robert Kelly (clinical) [Ep 5 · 22:45](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=1365)
- "Measuring the bar length from mid-axillary line to mid-axillary line and subtracting an inch is one method that works very well." — Robert Kelly (clinical) [Ep 5 · 23:29](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=1409)
- "It should be standard practice in patients with any difficulty in visualization to use some technique of sternal elevation during Nuss procedure." — Robert Kelly (guideline) [Ep 5 · 24:43](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=1483)
- "The most important part of the Nuss procedure, whatever techniques are used, is that the surgeon sees the tip of the introducer at all times—not just knowing it's in there somewhere, but actually seeing it—to minimize the likelihood of injuring the heart." — Robert Kelly (clinical) [Ep 5 · 26:02](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=1562)
- "The bar must be positioned medial to the pectus ridge so there is a rib providing counterforce; if placed very laterally, only the intercostal muscles prevent movement and they will strip or rip under the load." — Robert Kelly (clinical) [Ep 5 · 28:54](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=1734)
- "In patients who are growing, stabilizers on both sides of the bar can cause a wasp-waist effect when encased by scar, so they are generally placed on only one side." — Robert Kelly (clinical) [Ep 5 · 30:07](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=1807)
- "If a patient is over approximately 6 feet 2 inches tall, the chances of needing two bars are almost 100%." — Robert Kelly (clinical) [Ep 5 · 30:39](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=1839)
- "In multiple series, short-term complications of the Nuss procedure are few and intervention has been infrequent." — Robert Kelly (epidemiological) [Ep 5 · 33:03](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=1983)
- "In a series of past 2000 Nuss procedures, about 2.7% of patients required some sort of revision for bar displacement." — Robert Kelly (epidemiological) [Ep 5 · 33:14](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=1994)
- "The incidence of bar displacement has been cut to about half (approximately 1.35%) by using stabilizers and wrapping around the crossing of the bar to the rib with pericostal sutures." — Robert Kelly (clinical) [Ep 5 · 33:28](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=2008)
- "Most bar displacement now occurs due to some kind of marked force or trauma rather than spontaneous displacement." — Robert Kelly (clinical) [Ep 5 · 33:43](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=2023)
- "Bar allergy occurred in a little less than 1% (0.9%) of patients; screening for metal allergy has been performed since 2004 and has dramatically decreased the incidence." — Robert Kelly (epidemiological) [Ep 5 · 34:13](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=2053)
- "About 6.4% of pectus excavatum patients had clinical or patch test evidence of metal allergy." — Robert Kelly (epidemiological) [Ep 5 · 34:27](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=2067)
- "Wound infection occurred in 2.3% of patients, with more than 2/3 being superficial or cellulitis." — Robert Kelly (epidemiological) [Ep 5 · 34:40](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=2080)
- "Recurrence after Nuss procedure occurred in about 1.2% of patients." — Robert Kelly (epidemiological) [Ep 5 · 35:07](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=2107)
- "Why recurrence happens after pectus excavatum surgery is still poorly understood; it can occur even when the bar is left in for 3 years." — Robert Kelly (opinion) [Ep 5 · 35:16](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=2116)
- "The bar should remain in place for at least 2 years before removal, with preference for closer to 3 years than 2 years." — Robert Kelly (guideline) [Ep 5 · 36:39](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=2199)
- "In a study from Saint Etienne, France published in Journal of Pediatric Surgery, vacuum bell treatment was effective in pretty much eliminating pectus excavatum in 23 of 73 patients." — Robert Kelly (epidemiological) [Ep 5 · 37:19](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=2239)
- "In patients who are young (under approximately 10 years old), the vacuum bell can be very effective in lifting the chest up." — Robert Kelly (clinical) [Ep 5 · 37:58](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=2278)
- "In patients with recurrent pectus excavatum following a previous Ravitch operation, a Nuss procedure can elevate the chest to some extent but won't restore movement of the chest wall, and patients will have some restrictive process from scarring." — Robert Kelly (clinical) [Ep 5 · 39:06](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=2346)
- "Brace therapy for pectus carinatum is successful somewhere between 2/3 and 3/4 of the time." — Robert Kelly (epidemiological) [Ep 5 · 40:04](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=2404)
- "Because any operation carries more morbidity than almost any brace, it's hard to say one shouldn't start with brace treatment for most patients with pectus carinatum." — Robert Kelly (opinion) [Ep 5 · 40:27](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=2427)
- "Marcello Ferro's dynamic compression system brace solved two patient objections: it is comfortable (pressure can be adjusted) and it's concealable under even an opaque close-fitting t-shirt." — Robert Kelly (clinical) [Ep 5 · 41:23](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=2483)
- "The Ferro brace works approximately 3/4 of the time in Dr. Kelly's experience." — Robert Kelly (epidemiological) [Ep 5 · 42:00](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=2520)
- "Most patients with pectus carinatum do not have symptoms, but there is a small subset who complain of pain and exercise limitation who should be considered for operation." — Robert Kelly (clinical) [Ep 5 · 42:43](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=2563)
- "The reverse Nuss operation (Abramson procedure) works well in pectus carinatum patients with a flexible chest." — Robert Kelly (clinical) [Ep 5 · 43:13](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=2593)
- "There is a broad perception among surgeons who have done many Ravitch operations for carinatum that there is an extremely low recurrence rate after that procedure, as opposed to the 10% recurrence rate after excavatum Ravitch." — Robert Kelly (opinion) [Ep 5 · 43:43](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=2623)
- "There is a family tendency in pectus deformities in approximately 40% of patients, but the majority still don't have a family history." — Robert Kelly (epidemiological) [Ep 5 · 44:52](https://library.globalcastmd.com/watch/chest-wall-deformities-with-dr-robert-kelly-950?t=2692)
- "Haller index threshold of 3.25 originated from a retrospective study by Alec Haller in the 1980s comparing cases he fixed versus those he did not fix" (clinical) [Ep 6 · 4:24](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=264)
- "The Haller index study was not an earth-shattering study at the time but has been used consistently for 30 years" (opinion) [Ep 6 · 4:55](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=295)
- "Psychosocial aspects of growing up are very important, and severe deformities should be fixed for psychosocial well-being regardless of physical symptoms" (opinion) [Ep 6 · 1:50](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=110)
- "Insurance companies require documented symptoms and Haller index for approval of pectus repair" (guideline) [Ep 6 · 2:07](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=127)
- "Nickel allergy frequency in pectus patients is 2.8% (almost 3%) based on Nuss group data from 1200 patients" (host_summary) [Ep 6 · 24:10](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=1450)
- "In a randomized trial of 110 patients, epidural catheters were removed within 24 hours or could not be placed in almost 25% of patients despite experienced anesthesiologists" (host_summary) [Ep 6 · 18:09](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=1089)
- "Epidural group had longer OR time due to catheter placement, more phone calls to anesthesia, and greater hospital charges compared to PCA" (host_summary) [Ep 6 · 17:35](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=1055)
- "Pain scores generally favored epidural for the first 2 days, were flat on day 3, and favored PCA for the last couple of days" (host_summary) [Ep 6 · 17:55](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=1075)
- "In Kansas City series of 168 patients over 6 years, there were 6 infections (3.6%), 5 required incision and drainage, 3 developed recurrent infections, and 1 required early bar removal" (epidemiological) [Ep 6 · 19:47](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=1187)
- "Nuss group data from 1200 patients showed better results when bars were left in at least 24 months, with Dr. Nuss recommending 3 years" (host_summary) [Ep 6 · 24:26](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=1466)
- "Kansas City series of 300 pectus excavatum repairs using subxiphoid technique: 5% required two bars, 4% infection rate, 1.5% bar dislodgement or stabilizer discomfort, 4 patients had bar rotation (early experience), 2 patients required chest tube, no recurrences requiring reoperation, no cardiac injuries, mean hospitalization 4 days" (epidemiological) [Ep 6 · 25:27](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=1527)
- "There are approximately 14-15 reported cases of cardiac injury with the Nuss procedure worldwide" (epidemiological) [Ep 6 · 11:04](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=664)
- "The subxiphoid incision technique allows finger guidance of the bar across the mediastinum above the heart, which the Kansas City group considers the safest way to avoid cardiac injury" (clinical) [Ep 6 · 13:59](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=839)
- "Thoracoscopy is not that helpful for cardiac injury prevention according to Kansas City experience, though most surgeons worldwide outside Kansas City use thoracoscopy" (opinion) [Ep 6 · 13:07](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=787)
- "Transesophageal echo can identify adhesions between heart and sternum, particularly useful in redo cases where cardiac injury risk is higher from tethering" (clinical) [Ep 6 · 15:21](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=921)
- "Dynamic compression bracing for pectus carinatum is effective when correction requires less than 7.5 PSI pressure" (clinical) [Ep 6 · 30:08](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=1808)
- "Kansas City has braced 200 pectus carinatum patients with dynamic compression bracing and has performed only one or two open repairs in the past 4 years" (epidemiological) [Ep 6 · 33:08](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=1988)
- "Brace wearing is recommended for 6-20 months followed by retainer mode (6-12 hours daily)" (clinical) [Ep 6 · 30:44](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=1844)
- "The dynamic compression brace costs approximately $1500-2000 total (kit plus device), billed through the hospital to insurance" (clinical) [Ep 6 · 33:40](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=2020)
- "Magnetic mini-mover procedure (3MP) is in FDA trial, 18 months into enrollment with all patients implanted, requiring another 18 months of data collection" (host_summary) [Ep 6 · 28:21](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=1701)
- "Currarino-Silverman syndrome shows a characteristic comma deformity on lateral X-ray and requires open Ravitch-type repair" (clinical) [Ep 6 · 31:02](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=1862)
- "Cincinnati Children's uses functional cardiac MRI to assess contractility, shift, and cardiac impact from pectus deformities, along with other scoring indices beyond Haller" — Todd Ponsky (host_summary) [Ep 6 · 3:36](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=216)
- "Some severely deformed chests have normal Haller scores due to combined anterior-posterior discrepancies" (clinical) [Ep 6 · 4:09](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=249)
- "Rarely do pectus patients have documented palpitations or clear evidence they are not keeping up with peers in terms of cardiac output" (opinion) [Ep 6 · 2:35](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=155)
- "Some pectus patients have real costochondral pain that can be a surgical indication" (clinical) [Ep 6 · 2:59](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=179)
- "Cardiorespiratory symptoms in pectus patients remain debatable regarding clinical significance despite careers spent trying to prove their importance" (opinion) [Ep 6 · 3:07](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=187)
- "Pulmonology and cardiology consults are obtained when patients have symptoms without significant pectus deformity to rule out reactive airway disease or other cardiac issues unrelated to pectus" (clinical) [Ep 6 · 5:41](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=341)
- "Documentation of symptom relief related to surgery is important for insurance purposes, requiring workup even though consults typically return normal except for anatomical findings" (clinical) [Ep 6 · 5:54](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=354)
- "A bone hook through the subxiphoid incision can lift the sternum to gain an additional 1-2 millimeters of space for bar passage in very deep deformities" (clinical) [Ep 6 · 15:45](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=945)
- "A suction valve device in Germany is placed on the chest to lift it and facilitate bar passage, but is not approved in the United States" (clinical) [Ep 6 · 16:19](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=979)
- "Rib flaring occurs postoperatively, sometimes bilaterally or unilaterally, and most surgeons do nothing about it" (clinical) [Ep 6 · 20:34](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=1234)
- "When bars are removed at 3 years, families generally do not want rib flaring addressed because the pectus looks good and rib flaring is not as bad as the original deformity" (clinical) [Ep 6 · 23:14](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=1394)
- "Dr. Abramson in Buenos Aires has devised a minimally invasive operation for pectus carinatum with published 5-year experience" (host_summary) [Ep 6 · 31:44](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=1904)
- "Norfolk colleagues published on staged management of pectus carinatum including bracing and the Abramson procedure" (host_summary) [Ep 6 · 32:07](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=1927)
- "Passing the bar left to right (rather than right to left) may be safer because once past the heart on the left, the right side has less cardiac risk" (opinion) [Ep 6 · 12:20](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=740)
- "In deep pectus cases, thoracoscopy shows the heart where the bar crosses over it, making the right side less risky than the left" (clinical) [Ep 6 · 12:41](https://library.globalcastmd.com/watch/pectus-deformities-update-course-2015-990?t=761)
- "In pectus excavatum clinics, genetic evaluation primarily screens for Marfan syndrome and Ehlers-Danlos syndrome." (clinical) [Ep 8 · 0:00](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=0)
- "Marfan syndrome skeletal evaluation includes the wrist sign (thumb and pinky finger overlap when wrapped around wrist) and thumb protrusion past the ulnar border, assessing for long bone overgrowth relative to trunk." (clinical) [Ep 8 · 0:21](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=21)
- "Marfan syndrome skeletal findings include evaluation of arm span to height ratios and upper to lower segment ratios." (clinical) [Ep 8 · 1:00](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=60)
- "Additional Marfan skeletal findings include pectus excavatum, pectus carinatum, scoliosis, and hind foot deformities." (clinical) [Ep 8 · 1:07](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=67)
- "Marfan syndrome screening is motivated by cardiac risk (aortic dissection) and other complications including mitral valve prolapse and retinal detachments." (clinical) [Ep 8 · 1:19](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=79)
- "Marfan syndrome diagnosis now centers on cardiac findings, with echocardiogram or MRI as main tools to evaluate for dilated aortic root." (clinical) [Ep 8 · 1:38](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=98)
- "Marfan evaluation includes assessment for lens dislocations, and in suggestive cases, genetic testing of the fibrillin gene." (clinical) [Ep 8 · 1:55](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=115)
- "Patients with Marfan-like characteristics may warrant extended genetic evaluation for other syndromes involving TGF beta signaling, which contributes to aortic remodeling and long bone overgrowth." (clinical) [Ep 8 · 2:05](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=125)
- "Ehlers-Danlos syndrome is by far the more common condition evaluated in pectus clinics compared to Marfan syndrome." (epidemiological) [Ep 8 · 2:27](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=147)
- "Ehlers-Danlos syndrome represents a grouping of related connective tissue conditions, not a single entity." (clinical) [Ep 8 · 2:45](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=165)
- "Classic Ehlers-Danlos is caused by defects in collagen 5 and characterized by joint hypermobility and abnormal skin that is fragile, thin, with weak papery scars." (clinical) [Ep 8 · 3:00](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=180)
- "Vascular Ehlers-Danlos is caused by mutations in collagen 3 and involves internal organ fragility rather than primarily hypermobile joints." (clinical) [Ep 8 · 3:17](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=197)
- "Vascular Ehlers-Danlos screening focuses on family or personal history of ruptures (bowel, aortic, or uterine rupture)." (clinical) [Ep 8 · 3:52](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=232)
- "Vascular Ehlers-Danlos has genetic testing that is 99% sensitive." (clinical) [Ep 8 · 4:07](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=247)
- "Vascular Ehlers-Danlos is one of the least common conditions seen in pectus clinics." (epidemiological) [Ep 8 · 3:39](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=219)
- "Hypermobile Ehlers-Danlos is the type typically evaluated in pectus clinics, characterized by very flexible patients." (clinical) [Ep 8 · 4:23](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=263)
- "The Beighton score is a formal test of 9 different joints, scored 1 point for each side except the hips, used to assess hypermobility." (clinical) [Ep 8 · 4:41](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=281)
- "Beighton score criteria include: arm hyperextension past 10 degrees, pinky hyperextension past 90 degrees, thumb apposition to forearm, knee hyperextension past 10 degrees (all bilateral, 8 points total), and placing hands flat on floor without bending knees (assessing hip hypermobility)." (clinical) [Ep 8 · 4:52](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=292)
- "A Beighton score of 5 or more hypermobile joints meets criteria for generalized hypermobility." (clinical) [Ep 8 · 5:27](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=327)
- "Additional hypermobile Ehlers-Danlos findings include mild skin changes (mildly hyperextensible, easy bruising, scarring abnormalities, striae) and family history of hypermobility." (clinical) [Ep 8 · 5:35](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=335)
- "The dividing line between being flexible and having Ehlers-Danlos may be very fuzzy; diagnosis requires similar findings in family members and presence of clinical problems." (clinical) [Ep 8 · 6:01](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=361)
- "Hypermobile Ehlers-Danlos patients exhibit a constellation of findings: chronic pain, chronic headaches/migraines, TMJ dysfunction, easy bruising/bleeding, orthostatic hypotension/dizziness/blacking out with standing, episodes of racing heartbeat, chronic constipation with IBS, panic and anxiety disorders, and sleeping problems." (clinical) [Ep 8 · 6:32](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=392)
- "Most adult hypermobile Ehlers-Danlos patients presenting to clinic have almost all of the associated constellation of problems." (epidemiological) [Ep 8 · 7:12](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=432)
- "In children with hypermobile Ehlers-Danlos, problems may be very mild or not evident initially, but may emerge during puberty, which may coincide with consideration of pectus surgery." (clinical) [Ep 8 · 7:17](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=437)
- "The chronic pain aspect of hypermobile Ehlers-Danlos can influence risk for more pain from pectus surgery." (clinical) [Ep 8 · 7:33](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=453)
- "Hypermobility is a risk factor for fibromyalgia; 50% of teenagers diagnosed with fibromyalgia have hypermobility." (epidemiological) [Ep 8 · 7:42](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=462)
- "Fibromyalgia involves central sensitivity to pain, meaning patients are unable to filter out unwanted pain signals in the same way as other persons." (clinical) [Ep 8 · 7:56](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=476)
- "Hypermobile patients may be at risk for more problems with chronic pain due to central pain sensitivity mechanisms." (clinical) [Ep 8 · 8:08](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=488)
- "One clinician's screening approach for pectus patients includes checking for double-jointedness, Marfan appearance (arachnodactyly), and striae, with genetics referral if findings are present." (clinical) [Ep 8 · 8:41](https://library.globalcastmd.com/watch/genetics-pectus-innovations-1018?t=521)
- "Nothing is as good as epidural analgesia for pectus patients; On-Q pumps come second to epidural." — Centel Sadai (opinion) [Ep 7 · 0:29](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=29)
- "Seattle Children's Hospital has gone from epidural to On-Q pump recently and is having some issues." — Centel Sadai (host_summary) [Ep 7 · 0:45](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=45)
- "More than 95% of Cincinnati's pectus patients do not get a PCA along with epidural." — Centel Sadai (clinical) [Ep 7 · 1:28](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=88)
- "Older patients and young adults have more pain after pectus repair because of chest wall rigidity." — Centel Sadai (clinical) [Ep 7 · 2:24](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=144)
- "Patients with Ehlers-Danlos syndrome have extensive pain and often have pain even before surgery." — Centel Sadai (clinical) [Ep 7 · 2:35](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=155)
- "Recent literature shows that if a child and their parent have pain catastrophization (anticipating negative outcomes), they are more likely to have more pain after surgery." — Centel Sadai (host_summary) [Ep 7 · 3:29](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=209)
- "Most neurological risk with epidural in children is from hypoperfusion of spinal cord, not from traumatic placement." — Centel Sadai (clinical) [Ep 7 · 5:30](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=330)
- "On-Q pump outcomes depend on multiple factors: catheter size and length (5 cm too short, 7.5 cm better), introducer width (wider causes backflow leak), delivery rate, and location." — Don (clinical) [Ep 7 · 7:59](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=479)
- "Most On-Q data in thoracic surgery is from thoracotomy with subpleural tunneling, making it hard to extrapolate to pectus applications." — Don (opinion) [Ep 7 · 8:25](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=505)
- "Exparel (liposomal bupivacaine) is safer than plain local anesthetic because the treatment for local anesthetic toxicity is intralipid, and Exparel is already in intralipid." — Centel Sadai (clinical) [Ep 7 · 10:31](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=631)
- "In Cincinnati's donor nephrectomy experience with Exparel TAP blocks, patients go off PCA one day earlier, have less opioid-related adverse effects, and use less opioids." — Centel Sadai (clinical) [Ep 7 · 10:43](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=643)
- "Exparel is not approved for pediatric use by the FDA." — Centel Sadai (guideline) [Ep 7 · 10:52](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=652)
- "Some patients have localized reactions to Exparel impressive enough to require steroids, lasting 3 days." — Don (clinical) [Ep 7 · 11:23](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=683)
- "Cincinnati allows patients with epidurals to walk inside the room and outside with help; Foley catheters are removed the next day after surgery." — Centel Sadai (clinical) [Ep 7 · 12:05](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=725)
- "Cincinnati's surgical pain service sees patients minimum 3 times daily (morning, afternoon, evening rounds) and is available 24/7." — Centel Sadai (clinical) [Ep 7 · 14:12](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=852)
- "There is evidence in medical literature that meditation benefits include minimizing pain, anxiety, and improving immune function after surgery." — Centel Sadai (host_summary) [Ep 7 · 15:58](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=958)
- "About 20-30% of pectus patients experience chronic persistent post-operative pain, defined as pain score of 3 or more two months after surgery." — Centel Sadai (epidemiological) [Ep 7 · 18:00](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=1080)
- "If a patient is on 5 days in a row of oxycodone or any other opioid, the risk of dependence goes up significantly." — Centel Sadai (clinical) [Ep 7 · 19:50](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=1190)
- "A meta-analysis of 6 studies published last year found that compared to PCA, epidural provided better pain control the first 2 days after pectus repair." — Centel Sadai (host_summary) [Ep 7 · 21:42](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=1302)
- "Two studies from Kansas with 22% and 35% epidural failure rates showed epidural didn't help relieve pain as well as PCA, likely due to poor epidural placement success." — Centel Sadai (host_summary) [Ep 7 · 22:19](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=1339)
- "Cincinnati takes 10-15 minutes to place an epidural and achieves more than 95% success rate." — Centel Sadai (clinical) [Ep 7 · 23:13](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=1393)
- "With a good working epidural, Cincinnati sees zero pain scores immediately after surgery in the first 2-3 days, which was unheard of 10-15 years ago." — Centel Sadai (clinical) [Ep 7 · 23:28](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=1408)
- "Cincinnati uses local anesthetic-only epidural solution which does not cause urinary retention and is very dermatomal, blocking only thoracic dermatomes." — Centel Sadai (clinical) [Ep 7 · 23:46](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=1426)
- "Most Cincinnati pectus patients go home on the 3rd or 4th day after surgery." — Centel Sadai (clinical) [Ep 7 · 24:18](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=1458)
- "Cincinnati's epidural success rate is more than 95%, and the number of patients needing PCA on top of epidural is now less than 5% (was 14% in 2013)." — Centel Sadai (clinical) [Ep 7 · 25:02](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=1502)
- "There is evidence that if you give pregabalin or gabapentin one hour before surgery, it decreases pain after surgery significantly and need for opioid is significantly less." — Centel Sadai (host_summary) [Ep 7 · 25:45](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=1545)
- "Cincinnati uses IV methadone at lower doses (5 mg max) than adults (15-20 mg) because higher doses caused too much sedation in teenage pectus patients." — Centel Sadai (clinical) [Ep 7 · 27:10](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=1630)
- "Methadone can cause prolongation of QT interval with reports of ventricular arrhythmias, so Cincinnati monitors with EKG to ensure QT doesn't exceed 480 milliseconds." — Centel Sadai (clinical) [Ep 7 · 28:19](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=1699)
- "The number of Cincinnati patients needing any IV opioid in the first 2-3 days when they have epidural is less than 5%." — Centel Sadai (clinical) [Ep 7 · 28:47](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=1727)
- "Cincinnati stops epidurals at 6 AM on post-op day 3 without weaning (from 8 mL/hour to zero immediately)." — Centel Sadai (clinical) [Ep 7 · 31:27](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=1887)
- "The advantage of not using opioids in epidural solution is minimal; opioids cause more problems (itching, urinary retention) than benefit. Clonidine can provide the same pain relief without those side effects." — Centel Sadai (opinion) [Ep 7 · 31:56](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=1916)
- "Cincinnati uses high concentration ropivacaine (0.2%) for epidural; lower concentrations (0.12% or 0.15%) don't provide adequate pain relief." — Centel Sadai (clinical) [Ep 7 · 32:22](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=1942)
- "Mark Saxton reports that without routine Foley catheters, 1 in 7 pectus patients need to be catheterized for urinary retention." (host_summary) [Ep 7 · 34:14](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=2054)
- "Naloxegol is a medication similar to naloxone that doesn't cross the blood-brain barrier, so it relieves opioid-induced constipation without reversing analgesia." — Centel Sadai (clinical) [Ep 7 · 35:21](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=2121)
- "About 50% of Cincinnati's pectus patients get constipation the moment oxycodone is started." — Centel Sadai (epidemiological) [Ep 7 · 35:14](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=2114)
- "In spine surgery patients (equally or less painful than pectus) who get PCA instead of epidural, about 15% have respiratory depression (respiratory rate <8, oxygen saturation <90%) despite multimodal analgesia." — Centel Sadai (clinical) [Ep 7 · 36:52](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=2212)
- "There is evidence that if you use even one dose of methadone in the OR, it cuts back on opioid use significantly and improves pain control in the next two days." — Centel Sadai (host_summary) [Ep 7 · 41:13](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=2473)
- "Thoracic surgery including pectus is considered high risk for persistent post-operative pain; about 20-30% of pectus patients develop chronic pain (pain score >3 at 2 months post-op)." — Centel Sadai (epidemiological) [Ep 7 · 41:43](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=2503)
- "Children and young adults have higher risk of persistent post-operative pain than elderly patients." — Centel Sadai (host_summary) [Ep 7 · 42:08](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=2528)
- "When pain is managed without regional anesthesia, the barrage of noxious stimuli to the brain precipitates neuroplasticity, causing the brain to remember pain long-term (6-12 months after surgery)." — Centel Sadai (clinical) [Ep 7 · 42:41](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=2561)
- "Higher amounts of preoperative opioid use increase the risk for persistent pain; high opioid doses turn down opioid receptor genes, which is connected with persistent pain." — Centel Sadai (clinical) [Ep 7 · 43:17](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=2597)
- "Seattle studies show that if a child doesn't sleep well before surgery (disturbed sleep, short duration), they are at high risk for persistent pain." — Centel Sadai (host_summary) [Ep 7 · 43:48](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=2628)
- "Cincinnati performs preoperative CYP2D6 genetic testing; saliva or blood sample taken at surgical clinic, results available in EPIC within 2 days, covered by most insurance." — Centel Sadai (clinical) [Ep 7 · 44:26](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=2666)
- "CYP2D6 is the major liver enzyme that metabolizes most oral opioids including codeine, tramadol, oxycodone, and hydrocodone." — Centel Sadai (clinical) [Ep 7 · 44:26](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=2666)
- "There is evidence that codeine, tramadol, and hydrocodone are not safe in ultra-rapid metabolizers." — Centel Sadai (host_summary) [Ep 7 · 45:02](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=2702)
- "Ultra-rapid metabolizers are not good candidates for codeine, tramadol, or hydrocodone, but they are okay with morphine and hydromorphone." — Centel Sadai (clinical) [Ep 7 · 45:44](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=2744)
- "Cincinnati can reliably predict who will have respiratory depression by looking at their genes and genetic signature." — Centel Sadai (clinical) [Ep 7 · 48:27](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=2907)
- "In Cincinnati population, only 1-2% are ultra-rapid metabolizers; in African American and especially Ethiopian populations, ultra-rapid metabolizers can be as high as 29%." — Centel Sadai (epidemiological) [Ep 7 · 49:38](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=2978)
- "The FDA has warned against use of codeine following tonsillectomy; tramadol and hydrocodone warnings are under FDA review." — Centel Sadai (guideline) [Ep 7 · 50:00](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=3000)
- "Among currently available opioids, oxycodone is the least affected by CYP2D6 metabolism." — Centel Sadai (clinical) [Ep 7 · 50:13](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=3013)
- "Even extensive metabolizers (normal population) are at high risk for sedation and respiratory depression if they have coexisting morbidity like asthma or sleep apnea." — Centel Sadai (clinical) [Ep 7 · 51:01](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=3061)
- "Sedation always precedes respiratory depression; Cincinnati nurses monitor sedation using Ramsay sedation scale every shift to prevent respiratory depression." — Centel Sadai (clinical) [Ep 7 · 51:29](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=3089)
- "Cincinnati has not used naloxone for any pain patients in more than 3 years despite using maximum opioid amounts, attributed to aggressive monitoring." — Centel Sadai (clinical) [Ep 7 · 52:02](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=3122)
- "The 50-gene genetic panel costs $50; CYP2D6 testing costs less than $1 per gene." — Centel Sadai (clinical) [Ep 7 · 52:23](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=3143)
- "One gene (fatty acid amide hydrolase) associated with nausea, vomiting, and prolonged PACU stay saves more than $100 per patient when used to guide dosing, exceeding the cost of genotyping." — Centel Sadai (clinical) [Ep 7 · 52:42](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=3162)
- "Intercostal blocks are still good and better than nothing for preemptive pain control, but may miss one or two intercostal nerves and don't provide pain relief as good as epidural." — Centel Sadai (opinion) [Ep 7 · 53:23](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=3203)
- "Higher concentration of local anesthetic is better for preemptive analgesia, which is why Cincinnati places epidurals before surgery with high-concentration ropivacaine." — Centel Sadai (clinical) [Ep 7 · 53:44](https://library.globalcastmd.com/watch/pain-management-pectus-innovations-1015?t=3224)
- "Pectus carinatum can be corrected by a number of surgical and non-surgical techniques." (host_summary) [Ep 9 · 0:00](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=0)
- "Minimally invasive repair of pectus carinatum (Abramson or reverse Nuss procedure) can correct the pectus without cartilage resection." (host_summary) [Ep 9 · 0:08](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=8)
- "The two patients were 16-year-old boys who had onset of pectus carinatum at adolescence." (host_summary) [Ep 9 · 0:19](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=19)
- "Correction pressures between 6 and 7 pounds per square inch indicate moderate stiffness of the chest wall." (host_summary) [Ep 9 · 0:27](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=27)
- "Special equipment for this procedure includes 4-hole stabilizers, bendable rib protectors, and the Pioneer sternal cable system, in addition to the Zimmer Biomet pectus tray." (host_summary) [Ep 9 · 0:42](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=42)
- "The procedure is performed under general anesthesia with an epidural catheter for intraoperative and postoperative analgesia." (host_summary) [Ep 9 · 0:58](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=58)
- "Prophylactic antibiotics are given, and a Foley catheter is inserted and kept for 24 hours." (host_summary) [Ep 9 · 1:05](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=65)
- "Bar length is determined by measuring the distance between the two mid-axillary lines at the highest point of the carinatum after correction." (host_summary) [Ep 9 · 1:19](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=79)
- "The end of the bar on each side should correspond to the intercostal space between the two ribs where the stabilizers will be anchored." (host_summary) [Ep 9 · 1:33](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=93)
- "Ribs are cleared of all muscle attachments for a distance of approximately 3 centimeters." (host_summary) [Ep 9 · 1:57](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=117)
- "A 1-inch periosteal incision is made in the rib, and the periosteum is separated from the underlying bone anteriorly and posteriorly." (host_summary) [Ep 9 · 2:13](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=133)
- "A rib protector of similar size to the measured subperiosteal space is bent to the shape of the rib, and a cable is threaded through its holes." (host_summary) [Ep 9 · 2:37](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=157)
- "A small piece of dental wire is used to label the rib protector to facilitate removal from behind the rib in 2 to 3 years." (host_summary) [Ep 9 · 2:58](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=178)
- "A tunnel is created between the muscles and the bony chest wall using a long curved clamp and finger dissection from both sides meeting at the midpoint, completed with the least curved pectus tunneler." (host_summary) [Ep 9 · 3:27](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=207)
- "Sternal wire is placed around a notch in the bar just distal to the stabilizer to lock the bar and stabilizer in position." (host_summary) [Ep 9 · 3:52](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=232)
- "With pressure on the chest to achieve a corrected position, the crimps are locked on the anterior surface of the stabilizer." (host_summary) [Ep 9 · 4:15](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=255)
- "The bar is tightly anchored to 4 ribs, 2 on each side, with the process performed twice on each side." (host_summary) [Ep 9 · 4:24](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=264)
- "The rib protectors prevent the cables from cutting through the ribs." (host_summary) [Ep 9 · 4:32](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=272)
- "Excellent correction was achieved and maintained at one year after repair in both patients." (host_summary) [Ep 9 · 4:48](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=288)
- "In addition to correction of the pectus, lateral chest wall expansion occurred." (host_summary) [Ep 9 · 4:55](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1953?t=295)
- "Pectus carinatum can be corrected by a number of surgical and non-surgical techniques." (host_summary) [Ep 10 · 0:00](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=0)
- "Minimally invasive repair of pectus carinatum (Abramson or reverse Nuss procedure) can correct the pectus without cartilage resection." (host_summary) [Ep 10 · 0:08](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=8)
- "Correction pressures between 6 and 7 pounds per square inch indicate moderate stiffness of the chest wall in pectus carinatum." (host_summary) [Ep 10 · 0:27](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=27)
- "Special equipment for minimally invasive pectus carinatum repair includes 4-hole stabilizers, bendable rib protectors, and the Pioneer sternal cable system, in addition to the Zimmer Biomet pectus tray containing tunnelers and bars." (host_summary) [Ep 10 · 0:42](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=42)
- "The procedure is performed under general anesthesia with an epidural catheter for intraoperative and postoperative analgesia." (host_summary) [Ep 10 · 0:58](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=58)
- "Prophylactic antibiotics are given and a Foley catheter is inserted and kept for 24 hours during minimally invasive pectus carinatum repair." (host_summary) [Ep 10 · 1:05](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=65)
- "Bar length for pectus carinatum repair is determined by measuring the distance between the two mid-axillary lines at the highest point of the carinatum after correction." (host_summary) [Ep 10 · 1:19](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=79)
- "The end of the bar on each side should correspond to the intercostal space between the two ribs where the stabilizers will be anchored." (host_summary) [Ep 10 · 1:33](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=93)
- "Ribs are cleared of all muscle attachments for a distance of approximately 3 centimeters during the dissection phase." (host_summary) [Ep 10 · 1:57](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=117)
- "A 1 inch periosteal incision is made in the rib, and the periosteum separated from the underlying bone anteriorly and posteriorly for subperiosteal dissection." (host_summary) [Ep 10 · 2:13](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=133)
- "A rib protector is bent to the shape of the rib and a cable is threaded through its holes before being passed under the rib within the subperiosteal space." (host_summary) [Ep 10 · 2:37](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=157)
- "A small piece of dental wire is used to label the rib protector to facilitate removal from behind the rib in 2 to 3 years." (host_summary) [Ep 10 · 2:58](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=178)
- "A tunnel is created between the muscles and the bony chest wall using a long curved clamp and finger dissection from both sides meeting at the midpoint, completed with the least curved pectus tunneler." (host_summary) [Ep 10 · 3:27](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=207)
- "Sternal wire is placed around a notch in the bar just distal to the stabilizer to lock the bar and stabilizer in position." (host_summary) [Ep 10 · 3:52](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=232)
- "With pressure on the chest to achieve a corrected position, the crimps are locked on the anterior surface of the stabilizer using the Pioneer cable system." (host_summary) [Ep 10 · 4:15](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=255)
- "The bar is tightly anchored to 4 ribs, 2 on each side, after the cable tensioning process is performed twice on each side." (host_summary) [Ep 10 · 4:24](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=264)
- "Rib protectors prevent the cables from cutting through the ribs during pectus carinatum repair." (host_summary) [Ep 10 · 4:32](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=272)
- "Excellent correction was achieved and maintained at one year after minimally invasive pectus carinatum repair in both demonstrated cases." (host_summary) [Ep 10 · 4:48](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=288)
- "In addition to correction of the pectus, lateral chest wall expansion occurred after minimally invasive repair." (host_summary) [Ep 10 · 4:55](https://library.globalcastmd.com/watch/minimally-invasive-repair-of-pectus-carinatum-1954?t=295)

## Changelog
- Sep 8: 2 items added automatically
- Sep 7: 11 items added automatically

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