Pectus Excavatum: Consensus and Controversies in Clinical Practice.
Nicky Janssen1, Jean H T Daemen1, Elise J van Polen1
1Division of General Thoracic Surgery, Department of Surgery, Zuyderland Medical Centre, Heerlen, the Netherlands.
The Annals of Thoracic Surgery
|March 30, 2023
Summary
This study sought consensus on pectus excavatum care. International experts agreed on diagnostic protocols, surgical indications, and postoperative follow-up to standardize treatment for this common chest wall deformity.
Area of Science:
- Thoracic Surgery
- Congenital Deformities
- Medical Consensus
Background:
- Pectus excavatum is the most frequent congenital anterior chest wall deformity.
- Current diagnostic and surgical criteria lack standardization, leading to varied patient care.
- No established guidelines exist, contributing to heterogeneity in clinical practice.
Purpose of the Study:
- To evaluate consensus and identify controversies in the diagnostic protocol for pectus excavatum.
- To determine agreement on indications for surgical correction.
- To establish consensus on postoperative evaluation methods.
Main Methods:
- A three-round international survey was conducted among participants evaluating statements on pectus excavatum care.
- Consensus was defined as agreement from at least 70% of participants.
- A low response rate of 18% (57 participants) was noted.
Main Results:
- Consensus was reached on 18 out of 62 statements (29%).
- Agreed diagnostic measures include conventional photography, with ECG/echocardiography for cardiac concerns and spirometry for pulmonary issues.
- Consensus was achieved on surgical indications (symptomatic cases, progression) and postoperative imaging (plain chest radiograph) and follow-up (photography, physical exam).
Conclusions:
- A multiround survey facilitated the formation of international consensus on key aspects of pectus excavatum management.
- The findings aim to aid in the standardization of care for patients with pectus excavatum.
- Further efforts are needed to address the remaining areas of disagreement.
More Related Videos
15:11Surgical Fixation of Sternal Fractures: Preoperative Planning and a Safe Surgical Technique Using Locked Titanium Plates and Depth Limited Drilling
Published on: January 5, 2015
63.8K
07:41Echocardiographic Evaluation of Atrial Communications before Transcatheter Closure
Published on: February 8, 2022
3.8K
Related Concept Videos
01:27Pneumothorax-II
233
Pneumothorax is a medical condition defined by the buildup of air in the pleural space between the lungs and the chest wall. This accumulation of air can lead to partial or complete lung collapse, resulting in a range of clinical manifestations. Understanding the clinical presentation and effective management strategies is crucial for healthcare professionals in providing timely and appropriate care to individuals with pneumothorax.
Clinical Manifestations:
Clinical Manifestations:
233
01:26Flail Chest-II
219
Managing flail chest, a condition characterized by a segment of the chest wall moving independently from the rest of the thoracic cage, requires a comprehensive approach. It includes a thorough assessment of the patient's condition, a diagnostic evaluation to determine the extent of the injury, and the implementation of appropriate medical interventions tailored to the individual's needs.
Assessment:
1. Clinical Evaluation:
History:
Assessment:
1. Clinical Evaluation:
History:
219
01:24Chest Physiotherapy
567
Chest Physiotherapy (CPT) is a therapeutic technique used in respiratory care to improve ventilation, clear bronchial secretions, and enhance the efficiency of respiratory muscles. This therapy includes three primary procedures: postural drainage, percussion, and vibration. It can be performed on spontaneously breathing patients and those who are intubated and mechanically ventilated.
Purpose
CPT is primarily used for patients with excessive bronchial secretions who have difficulty clearing...
Purpose
CPT is primarily used for patients with excessive bronchial secretions who have difficulty clearing...
567
01:28Pleural Effusion II: Symptoms and Management
226
Pleural Effusion Overview
A pleural effusion is the abnormal collection of fluid between the parietal and visceral pleura layers of tissue that form the lining of the lungs and chest cavity. It can occur independently or due to surrounding parenchymal diseases, such as infection, malignancy, or inflammatory conditions.
Clinical Manifestations:
A pleural effusion is the abnormal collection of fluid between the parietal and visceral pleura layers of tissue that form the lining of the lungs and chest cavity. It can occur independently or due to surrounding parenchymal diseases, such as infection, malignancy, or inflammatory conditions.
Clinical Manifestations:
226
01:29Pulmonary Embolism II: Diagnostic Studies and Interprofessional Care
16
Diagnosing Pulmonary EmbolismDiagnosing pulmonary embolism (PE) involves clinical assessment and advanced imaging tests. The preferred diagnostic tool is the spiral (helical) CT scan or CT angiography (CTA), which uses intravenous contrast media to visualize the pulmonary vasculature and identify emboli.A ventilation-perfusion (V/Q) scan is an alternative for patients unable to receive contrast media. This scan includes both perfusion and ventilation scanning. Perfusion scanning involves...
16
01:21Barrett Esophagus-II: Clinical Manifestations and Management
237
Individuals with Barrett's esophagus are often asymptomatic, but they may experience symptoms commonly associated with GERD, such as heartburn and acid regurgitation. Additional symptoms can include difficulty swallowing, chest pain, unintentional weight loss, blood in the stool (which may appear black, tarry, or bloody), and episodes of vomiting.
To diagnose Barrett's esophagus, healthcare providers often recommend an endoscopy for those showing symptoms of acid reflux. The procedure...
To diagnose Barrett's esophagus, healthcare providers often recommend an endoscopy for those showing symptoms of acid reflux. The procedure...
237