Radiology: Pectus Innovations
With Dr. Eric Crotty & Dr. Michael Taylor · StayCurrentMD
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Pectus Excavatum 58 items
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Educational content from recorded physician discussions — not medical advice. Talk to your (or your child's) care team about your situation.
Video
Pectus - Preoperative Assessment - Radiology and Cardiac Evaluation
Dr. Todd Ponsky · 44 min · Published Nov 2018
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Chest Wall Deformities with Dr. Robert Kelly
46 min · Published Jan 2017
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Interesting Cases & Surgical Approaches: Pectus Innovations
44 min · Published Oct 2015
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Pectus - Physiologic Consequences and Research
22 min · Published Nov 2018
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Physiology: Pectus Innovations
21 min · Published Oct 2015
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Pectus - Surgical Approaches for Failed Repair
44 min · Published Nov 2018
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What the experts said
Respiratory phase affects Haller index measurements; some patients with clinical pectus have normal Haller index at end inspiration but abnormal at end expiration
The Haller index was based on an observational study, not a rigorous scientific prospective study
Cardiac MRI for pectus assessment uses no contrast and takes approximately 25 minutes
Echocardiogram image quality in pectus patients is poor because the right ventricle and sternum are in the very near field of the transducer
Approximately 15% of pectus patients in the study (197 total) had right ventricular ejection fraction less than 50%
Normal right ventricular ejection fraction is considered to be 50%
Patients with RV compression had depressed right ventricular ejection fractions, with worse function when compression was on the free wall versus the RA-RV groove
Children can have right ventricular ejection fractions in the 40s and be asymptomatic
Exercise testing can reveal decreased RV function that is not apparent at rest in children
As pectus patients age, the heart appears to get extruded into the left chest
The anatomical assessment portion of cardiac MRI is very straightforward and uses fairly basic sequences
Most MRI scanners and centers should be able to perform cardiac MRI for pectus assessment as the sequences are fairly basic
Children tolerate MRI very well, especially with video goggle technology allowing them to watch movies during the procedure
MRI can be performed on patients with pectus bars in place, with only minimal localized artifact where the bar is on top of the heart
Insurance companies require documentation of abnormal indices and cardiac dysfunction to approve pectus repair
Providing multiple indices (Haller, correction, depression) plus evidence of cardiac dysfunction has been effective in reversing insurance denials
When the sternum presses on the free wall of the right ventricle, it affects right ventricular function
Right ventricular strain is markedly decreased in the free wall when compressed by pectus
Cardiac MRI reports aortic root dimensions and can detect mitral valve prolapse, important in Marfan patients
Younger age at CT exposure and higher CT dose increase long-term risk of developing malignancy
Pediatric tissues have cells that divide more frequently and rapidly, increasing likelihood of radiation-induced DNA breaks and long-term complications
Standard CT dose for pectus can deliver up to 7 millisieverts of radiation, equivalent to 2 years of background radiation
There is data suggesting increased risk of malignancy long term from even one CT scan, with risk increasing the younger the patient
When operating on younger patients, bars need to be shorter to avoid impeding chest wall growth
Overcorrection converting excavatum to carinatum can occur, particularly in patients with connective tissue disorders
Haller found that patients with a Haller index greater than 3.25 were candidates for operation
Correction index greater than 10% shows no overlap between normal and abnormal patients
Depression index greater than 0.2 is the cutoff between normal and abnormal patients
Dr. Park in Korea, who performs the largest number of pectus repairs globally, suggests repair is safe in patients older than 3 years
Dr. Park reports seeing fewer asymmetric pectus patients because he corrects them at younger ages