Eur J Pediatr Surg
DOI: 10.1055/s-0037-1604427
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Advantages of Cardiac Magnetic Resonance Imaging for Severe Pectus Excavatum Assessment in Children

Mariela Dore1, Paloma Triana Junco1, Monserrat Bret2, Manuel Gómez Cervantes1, Martha Muñoz Romo1, Javier Jiménez Gómez1, Ana Pérez Vigara2, Manuel Parrón Pajares2, José Luis Encinas1, Francisco Hernandez1, Leopoldo Martinez1, Manuel López Santamaría1, Carlos De La Torre1
  • 1Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain
  • 2Department of Pediatric Radiology, Hospital Universitario La Paz, Madrid, Spain
Further Information

Publication History

18 April 2017

21 June 2017

Publication Date:
31 July 2017 (eFirst)

Abstract

Aim Cardiac function can be impaired in patients with pectus excavatum (PE) due to anatomic and dynamic compression of the heart. Efforts for radiation dose reduction in imaging techniques have allowed cardiac magnetic resonance imaging (c-MRI) to play a major role in PE assessment. The aim of our study is to describe the findings of c-MRI 18 months after we changed the PE assessment protocol from chest computed tomography to c-MRI.

Patients and Methods Since mid-2015 all patients with severe PE (suspected Haller's index > 3.2) were assessed with inspiratory and expiratory c-MRI. A retrospective analysis of these patients was performed evaluating the following parameters: (1) Radiologic PE indexes (Haller's, correction and asymmetry indexes; and sternal rotation) and (2) cardiac function (including left and right ventricle ejection fraction).

Results A total of 20 patients met the inclusion criteria. Dynamic imaging showed a significant difference during inspiration and expiration of the Haller's index 3.85 (range: 3.17–7.3) versus 5.10 (range: 3.85–10.8) (p < 0.05), and correction index (26.86% vs. 36.84%, respectively, p < 0.05). The sternal rotation was 14.5 (range: 0–36). c-MRI analysis disclosed a right ventricle ejection fraction of 50.3%. (normal range: 61% [54–71%]). Echocardiographic imaging underestimated the functional repercussion of PE in all patients.

Conclusions Initial results show that PE assessment by c-MRI allows a radiation-free image of the chest wall deformity during the entire breathing process. Also, it permitted the evaluation of the influence of sternum impingement on cardiac function. These findings allowed us a careful surgical evaluation and preoperative planning.