Deviggiano Alejandro, Carrascosa Patricia, Vallejos Javier, Bellia-Munzon Gaston, Vina Natalia, Rodríguez-Granillo Gaston A, Martinez-Ferro Marcelo
Department of Computed Tomography and Magnetic Resonance Imaging, Diagnóstico Maipu, Buenos Aires, Argentina.
Department of Computed Tomography and Magnetic Resonance Imaging, Diagnóstico Maipu, Buenos Aires, Argentina.
J Pediatr Surg. 2018 Nov;53(11):2294-2298. doi: 10.1016/j.jpedsurg.2018.05.015. Epub 2018 May 23.
BACKGROUND/PURPOSE: In pectus excavatum (PE) patients owing to the location of the heart in the chest cavity, the most affected site of compression by the depressed chest wall is the right heart, and surgical repair has shown to provide a significant relief in the RH cavities compression. Our aim was to explore the relationship between the site of right cardiac compression, chest wall indexes (CT-CWI) and the sternal torsion angle (STA) based on cardiac magnetic resonance (CMR) and computed tomography (CT) among PE patients.
We included PE patients with no previous surgical correction referred to CMR and chest CT imaging as presurgical evaluations. The following CT-CWI were calculated: Haller Index (HI), correction index (CI) and STA. A CMR compression classification (CMR-CC) was implemented based on the analysis (in the horizontal long axis plane at end of diastole) of the right cardiac compression site, caused by the thoracic cage (sternum/ribs): Type 0 (T0): absence of cardiac compression; Type 1 (T1): compression of the lateral wall of the right ventricle (RV) without involvement of the atrioventricular (AV) groove; Type 2 (T2): compression of the RV involving the AV groove.
Sixty PE patients underwent CMR and chest CT. Fifty (81%) patients were male, and the median age was 17.5 (14.0; 23.0) years. T0, T1 and T2 were found in 14 (23%), 27 (45%) and 19 (32%) patients. There were significant differences between types with regard to the HI (T0 3.9 ± 1.1, T1 4.8 ± 2.0, T2 6.4 ± 3.1, p < 0.009) and to the CI (T0 22.1 ± 10.4%, T1 31.6 ± 16.1%, T2 46.9 ± 16.3% p < 0.0001) and STA (T0 9.1 ± 7.9°, T1 12.7 ± 10.3°, class T2 23.0 ± 13.6°p = 0.001) respectively.
In this study, we established a cardiac magnetic resonance compression classification of patients with pectus excavatum comprising a simple discrimination of cardiac compression sites, which were related to chest wall indexes.
Study of Diagnostic Test.
Level II.
背景/目的：在漏斗胸（PE）患者中，由于心脏位于胸腔内，凹陷胸壁造成压迫的最主要部位是右心，手术修复已证明可显著缓解右心腔的压迫。我们的目的是基于心脏磁共振成像（CMR）和计算机断层扫描（CT），探讨PE患者右心压迫部位、胸壁指数（CT-CWI）和胸骨扭转角（STA）之间的关系。
我们纳入了未曾接受过手术矫正的PE患者，将CMR和胸部CT成像作为术前评估。计算以下CT-CWI：哈勒指数（HI）、矫正指数（CI）和STA。基于对胸廓（胸骨/肋骨）导致的右心压迫部位的分析（在舒张期末的水平长轴平面），实施CMR压迫分类（CMR-CC）：0型（T0）：无心脏压迫；1型（T1）：右心室（RV）侧壁受压，不涉及房室（AV）沟；2型（T2）：RV受压，涉及AV沟。
60例PE患者接受了CMR和胸部CT检查。50例（81%）患者为男性，中位年龄为17.5（14.0；23.0）岁。14例（23%）、27例（45%）和19例（32%）患者分别为T0、T1和T2型。不同类型在HI（T-0 3.9±1.1，T1 4.8±2.0，T-2 6.4±3.1，p<0.009）、CI（T0 22.1±10.4%，T1 31.6±16.1%，T2 46.9±1-6.3%，p<0.0001）和STA（T0 9.1±7.9°，T1 12.7±10.3°，T2型23.0±13.6°，p=0.001）方面存在显著差异。
在本研究中，我们建立了漏斗胸患者的心脏磁共振压迫分类，包括对与胸壁指数相关的心脏压迫部位的简单区分。
诊断试验研究。
二级。
