Hyung Joo Park

A Next-Generation Pectus Excavatum Repair Technique: New Devices Make a Difference

BACKGROUND When performing pectus excavatum repair using a pectus bar, stabilization of the bar is crucial. However, since 2007, we have been developing new devices to achieve a bar dislocation rate of zero. The purpose of this study is to determine whether our next-generation approach makes it possible to achieve our goal. METHODS We analyzed the results of various bar fixation techniques in a patient cohort of 1,816 consecutive pectus excavatum repairs using a pectus bar between 1999 and 2012. Techniques that have been evolving were a stabilizer (STB, 1999); multipoint pericostal suture fixation (MPF, 2001); and the new devices: claw fixator (CFT, 2007) and hinge plate (HP, 2009). The claw fixator is used for sutureless bar fixation by hooking the rib with blades, whereas the hinge plate prevents intercostal muscle stripping at the hinge points. Patients were divided into groups according to the technique used, and the outcomes were compared. RESULTS Early bar dislocation rates were as follows: STB 3.33% (6 of 180), MPF 0.56% (4 of 760), CFT 0.57% (4 of 699), and CFT+HP 0% (0 of 177; p = 0.002). Reoperation rates were as follows: STB 5% (9 of 180), MPF 1.57% (12 of 760), CFT 2.10% (11 of 699), and CFT+HP 3.38% (6 of 177; p = 0.042). Total complication rates were also lower in the CFT+HP group (14.1%, 25 of 177) than the STB group (22.7%, 41 of 180; p < 0.01). CONCLUSIONS By using the next-generation approach with the claw fixator plus hinge plate rather than the conventional stabilizer, we were able to reduce the bar dislocation rate and complications. We recommend that the conventional stabilizer be replaced with the claw fixator and hinge plate.

Correction of pectus excavatum with breast hypoplasia using simultaneous pectus bar procedure and augmentation mammoplasty.

AbstractMost women with asymmetric pectus excavatum suffer from hypoplastic breasts. Hence, aesthetic correction of pectus excavatum has to address thoracic wall deformity, breast hypoplasia, and asymmetry.In retrospective series, 21 patients with a diagnosis of pectus excavatum with hypoplastic breasts were corrected using the pectus bar procedure and subpectoral augmentation mammoplasty. Results were assessed by analyzing prospectively collected data and calculating pectus indices from computed tomographic scans. At 12 months postoperatively, cosmetic evaluations were performed by the patients and by an independent, board-certified plastic surgeon using score from 0 (very poor) to 4 (very good).Cosmetic results evaluated by plastic surgeon were good (3.33 ± 0.03) and patient satisfaction was high (3.52 ± 0.03). Furthermore, indices of pectus excavatum were corrected to near normal.The authors consider that the pectus bar procedure with subpectoral augmentation mammoplasty is useful for the aesthetic correction of pectus excavatum with hypoplastic breasts.

Cardiac Morphologic Changes After the Nuss Operation for Correction of Pectus Excavatum

BACKGROUND Pectus excavatum results in compression of the heart and may compromise cardiac function. Several studies have shown that surgical correction improves cardiac function as assessed on echocardiography. However, morphologic changes to support this have not been reported. METHODS Between July and December 2011, 109 patients underwent the Nuss operation. We measured the Haller index and other variables. To identify the location of the heart within the chest cavity, the distances from the middle of the spine to the right and left heart walls and from the anterior border of the spine to the anterior and posterior heart walls were measured. To characterize dimensional changes, the anteroposterior, transverse lateral, and right and left oblique longest lengths were measured. RESULTS The postoperative Haller index was significantly different from the preoperative one (2.52±0.40 versus 4.50±1.45; p<0.001). The location changes in the anterior, rightward, and leftward directions were 4.97±8.03 mm (p<0.01), 1.66±7.89 mm (p=0.027), and -2.70±11.12 mm (p=0.01), respectively. The dimensional changes in anteroposterior and right oblique lengths were 5.42±6.42 mm and 16.33±7.77 mm (p<0.01), respectively. CONCLUSIONS The heart moved positively in the anterior and rightward directions and negatively in the leftward direction, and the anteroposterior and right oblique dimensions were increased after surgical correction. These data suggest that the heart tends to return to a normal position and shape, and that these changes may contribute to improvement in cardiac function.

New Computerized Indices for Quantitative Evaluation of Depression and Asymmetry in Patients With Chest Wall Deformities

An evaluation index that can quantitatively assess the severity of chest wall deformities is essential to prepare and assess corrective surgical operations for patients with these deformities, including funnel chest patients. In previous studies, our group proposed several automatically calculated indices that represent the severity of depression and asymmetry in the chest wall. These indices showed sufficient performance in most cases of deformities, including those involving asymmetric and symmetric depression; however, their linearity declined when assessing complex deformities. The purpose of this study is to propose two automated indices that provide linear evaluation output for all types of chest wall deformities, including complex deformities, and to evaluate their performance and clinical feasibility. Six reference chest wall boundary curves were obtained from 60 computed tomography (CT) images of a normal chest. Next, an active contour model-based image processing technique was used to extract boundary curves from images of patients with real chest wall deformities. Third, the required parameters were extracted from the boundary curves and the targeted indices were calculated. Finally, the performance of the proposed indices was evaluated using 33 synthetic images and 60 real chest CT images of patients with chest wall deformities. The newly proposed indices can be automatically calculated from the original CT images and showed sufficient performance for all types of chest wall deformities. We believe that the newly proposed indices can facilitate pre- and postoperative evaluation of chest wall deformities in clinical practice.