The search for stability: bar displacement in three series of pectus excavatum patients treated with the Nuss technique

OBJECTIVES: To compare bar displacement and complication rates in three retrospective series of patients operated on by the same surgical team. METHOD: A retrospective medical chart analysis of the three patient series was performed. In the first series, the original, unmodified Nuss technique was performed. In the second, we used the ''third point fixation'' technique,and in the last series, the correction was performed with modifications to the stabilizer and stabilizer position. RESULTS: There were no deaths in any of the series. Minor complications occurred in six (4.9%) patients: pneumothorax with spontaneous resolution (2), suture site infection (2), and bar displacement without the reoperation need (2). Major complications were observed in eight (6.5%) patients: pleural effusion requiring drainage (1), foreign body reaction to the bar (1), pneumonia and shock septic (1), cardiac perforation (1), skin erosion/seroma (1), and displacement that necessitated a second operation to remove the bar within the 30 days of implantation (3). All major complications occurred in the first and second series. CONCLUSION: The elimination of fixation wires, the use of shorter bars and redesigned stabilizers placed in a more medial position results in a better outcome for pectus excavatum patients treated with the Nuss technique. With bar displacement and instability no longer significant postoperative risks, the Nuss technique should be considered among the available options for the surgical correction of pectus excavatum in pediatric patients

Correspondence on Should the Ravitch Procedure to Correct Pectus Excavatum Be Avoided in Young Children?

To the editor: In addition to the excellent outcome they obtained, the case reported by Rim and Park [1] shows the boldness and inventiveness of the authors: boldness for performing the fourth surgical procedure (previously, the patient had undergone the Ravitch procedure, correction with 2 metal bars, and removal of the bars) for the repair of recurrent pectus excavatum (PE), and inventiveness for proposing a 3-dimensional-printed artificial thoracic wall, which as far as we know is an unprecedented treatment, to correct this serious defec

Interatrial sulcus opening during multiple grafts harvesting for heart and lung tranplantation: anatomical study

OBJETIVO: Avaliar o impacto que a abertura do sulco interatrial representa em termos de ganho de parede de átrio esquerdo quando da retirada de coração e pulmões para transplante. MÉTODOS: Foi estudada a medida do átrio esquerdo, pela face mediastinal direita, obtida após dissecção do sulco interatrial em 50 cadáveres humanos. O ganho em extensão de parede do átrio esquerdo após a abertura do sulco interatrial foi correlacionado com as variáveis sexo, idade e grupo étnico. RESULTADOS: O ganho obtido através da abertura do sulco interatrial à direita foi, na média, de 1,31 cm (variação de 0,3 cm a 2,5 cm). Quando esse valor foi relacionado à variável sexo, observou-se que nos 27 (54%) casos do sexo masculino o ganho foi de 1,19 cm ± 0,6 cm e, nos 23 (46%) do sexo feminino, o ganho foi de 1,21 cm ± 0,5 cm (p = 0,895). Em relação à idade, observou-se que nos 24 (48%) casos com idade menor do que 50 anos o valor foi de 1,08 cm ± 0,6 cm e, nos 26 (52%) com idade maior ou igual a 50 anos, 1,36 cm ± 0,6 cm (p = 0,088). Em relação ao grupo étnico, observou-se que o valor do ganho nos 31 (62%) casos de brancos foi de 1,34 cm ± 0,5 cm e, nos 19 (38%) de pacientes não-brancos, 1,27 cm ± 0,4 cm (p =0,589). CONCLUSÃO: Embora não haja correlação entre o ganho obtido com o sulco interatrial dissecado e as variáveis sexo, idade e grupo étnico, nossos resultados confirmam que a abertura do sulco interatrial pode propiciar acesso a uma extensão significativa de parede atrial esquerda na separação do coração dos pulmões.OBJECTIVE: To evaluate the impact of the interatrial sulcus opening regarding of left atrium gain when harvesting heart and lungs for transplantation. METHODS: It was evaluated the left atrium dimension, from the right mediastinal side, after the interatrial sulcus dissection in fifty human cadaver. The interatrial sulcus gain was related with gender, age and ethnic group. RESULTS: The gain observed through right interatrial opening was, in media, 1.31cm (0.3 cm to 2.5cm). When that value was related to the variable gender it was observed that in the 27 (54%) cases of the male the earnings was 1.19 cm ± 0.6 cm and, in the 23 (46%) female, 1.21 cm ± 0.5 cm (p = 0.895). In relation to age, it was observed that, in the 24 (48%) cases with smaller age than 50 years, the value was 1.08 cm +0.6 cm and, in the 26 (52%) with larger age or same to 50 years, 1.36 cm ± 0.6cm (p = 0.088). In relation to ethnic group, it was observed that the value of the earnings in the 31 (62%) cases of whites it was 1.34 cm ± 0.5 cm and, in the 19 (38%) non white, 1.27 cm ± 0.4 cm (p = 0.589). CONCLUSION: Heart grafts and lung grafts must be harvested maintaining adequate segments of left atrium near the heart and the pulmonary veins of the lungs that will be transplanted. Although there is no correlation between the observed gain in the interatrial sulcus dissection and the variables gender, age and ethnic group, our results confirm that the interatrial sulcus opening can give access to significant extension of left atrium wall when separating heart and lungs

Video-assisted thoracoscopic implantation of a diaphragmatic pacemaker in a child with tetraplegia: indications, technique, and results

We report the case of a child with tetraplegia after cervical trauma, who subsequently underwent diaphragmatic pacemaker implantation. We reviewed the major indications for diaphragmatic pacing and the types of devices employed. We highlight the unequivocal benefit of diaphragmatic pacing in the social and educational reintegration of individuals with tetraplegia