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

Mariela Dore; Paloma Triana Junco; Monserrat Bret; Manuel Gomez Cervantes; Martha Muñoz Romo; Javier Jimenez Gomez; Ana Perez Vigara; Manuel Parron Pajares; Jose Luis Encinas; Francisco Hernandez; Leopoldo Martinez; Manuel Lopez Santamaria; Carlos De La Torre

doi:10.1055/s-0037-1604427

European Journal of Pediatric Surgery, Table of Contents

Eur J Pediatr Surg 2018; 28(01): 034-038
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 Dore

¹Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain

,

Paloma Triana Junco

¹Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain

,

Monserrat Bret

²Department of Pediatric Radiology, Hospital Universitario La Paz, Madrid, Spain

,

Manuel Gomez Cervantes

¹Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain

,

Martha Muñoz Romo

¹Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain

,

Javier Jimenez Gomez

¹Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain

,

Ana Perez Vigara

²Department of Pediatric Radiology, Hospital Universitario La Paz, Madrid, Spain

,

Manuel Parron Pajares

²Department of Pediatric Radiology, Hospital Universitario La Paz, Madrid, Spain

,

Jose Luis Encinas

¹Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain

,

Francisco Hernandez

¹Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain

,

Leopoldo Martinez

¹Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain

,

Manuel Lopez Santamaria

¹Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain

,

Carlos De La Torre

¹Department of Pediatric Surgery, Hospital Universitario La Paz, Madrid, Spain

› Author Affiliations

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.

Conclusion 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.

Keywords

pectus excavatum - cardiac MRI - children - preoperative assessment

Full Text

References

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