January 2016 - Cincinnati Children`s Hospital

Quarter 3
January
2016
Surgery
COMMITTED TO IMPROVING THE QUALITY OF LIFE FOR
EVERY PATIENT
The Division of Pediatric General and Thoracic Surgery houses an internationally
renowned staff of pediatric surgeons prepared to exceed your expectations and
provide the care your patient deserves.
Chest Wall Deformities:
What are they & How are they treated?
Chest wall deformities, also known as Pectus, can present as
an indentation in the chest (Pectus Excavatum) or a protrusion
of the chest wall (Pectus Carinatum). These chest wall
deformities can impact your patient’s breathing, cardiac
function, posture and appearance.
Please see the back portion of this newsletter for more
information on what Pectus is and how the Pectus Program at
Cincinnati Children’s is one of the leading institutions for the
treatment of chest wall deformities .
FROM ASSOCIATE CHIEF OF STAFF OF
SURGICAL SERVICES, DR. RICHARD FALCONE
Since the expansion of our Liberty Campus, we are excited to say we have been able to successfully and safely
keep the treatment of appendicitis, pyloric stenosis, minor abscesses at Liberty. While Burnet still accepts, treats
and admits patients with these conditions, we are now able to treat patients in the Liberty area closer to home
without having to transport to our Burnet campus. This has been a big time and money saver for parents in the
Liberty area.
This past year we successfully treated two siblings from the Liberty area for appendicitis. The first sibling saw us
at our Liberty campus prior to it becoming a full service hospital. To provide the level of care needed, the patient had to be transported to our
Burnet campus after being evaluated at Liberty. Although it was necessary at the time, it was an inconvenience to the patient and family to
transfer to Burnet where they had to be reevaluated and admitted. When the second sibling came to Liberty for appendicitis, we were able to
admit and treat the patient at the same location. Thanks to the efforts put forth to become a full service hospital, the patient was able to
be evaluated and admitted in a short period of time saving time and money for mom and dad and ensuring the child received prompt and
efficient care close to home.
In addition to providing care closer to home, our Liberty campus is equipped with telemedicine features in each in-patient room. This feature
is a huge benefit to our patients and families because it allows them to talk to the rounding physician at campus or even consult with their
surgeon even if he or she is not on campus. It also offers 24/7 coverage by Surgical Advanced Practice Practitioners to ensure your patients
receive the care they need when they need it most. Patients can be seen at our Emergency Department or the Urgent Care facility at Liberty.
The hours for the Urgent Care are Monday through Friday, 6 pm - midnight and on Saturdays, Sundays and holidays from Noon - midnight.
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The Pectus Program of Cincinnati
Lead by Dr. Rebeccah Brown and Dr. Victor Garcia, the Pectus Program at Cincinnati Children’s
Hospital offers a holistic approach to treating chest wall deformities in adolescents.
Pectus Excavatum
Pectus Carinatum

Also known as “funnel chest”

Also known as “pigeon chest”

Occurs when abnormally growing
cartilage pushes the sternum inward

When the sternum is pushed outward


Causes compression of the heart and lungs
Not generally life threatening but can cause
pain during exercise or times of increased breathing

Occurs in one in 500 to 1,000 children, primarily Caucasian males
and females


Corrected through Minimally Invasive Surgery (Nuss Procedure)
Non-surgical treatment available via External Bracing (Orthotic)
Technique. In children up to age 18 who have mild to moderate
Pectus Carinatum and are highly motivated to avoid surgery, the
use of a custom-fitted chest-wall brace pushing directly on the sternum produces excellent outcomes.
Did You Know?

Patient Symptoms: Extreme Fatigue, Lack of exercise tolerance, Difficulty breathing
- Cincinnati Children’s was one of the first institutions to use Cardiac MRIs to provide higher quality information as well as eliminating patient
exposure to ionizing radiation. These MRIs provide evidence of the compression Pectus Excavatum has on cardiac functions and cardiac
displacement.
- Recent research from the Mayo Clinic has shown with correction of Pectus excavatum, cardiac output improved from 54% to 77%.
- Pulmonary Stress testing measures the amount of oxygen delivered with exercise. A variety of studies show VO2 Max and EF are
significantly lower in Pectus Excavatum patients but with surgery improve drastically. Ongoing studies at the Pectus Program have identified
pediatric pectus patients with RV compression had significantly lower REVF compared to those without RV compression.
- These symptoms become increasingly worse as the patient enters adulthood which is why it is so important

Genetic Conditions: Connective tissue disorders such as Marfan Syndrome, Ehlers Danlos Syndrome, Postural orthostatic tachycardia
syndrome (POTS), and Fibromyalgia are commonly seen.
- These connective tissue disorders are known to have cardiac risks associated with them and are associated with chronic pain.
- Intensifies the pain associated with Pectus deformities.
- If any of our patients show symptoms of these syndromes, we have genetic testing done to determine if they are at risk for cardiac risks
from surgery as well as severe pain after surgery.

Pain Service: Our world renowned Pain Service Team is an integral member of our team. We embrace traditional and alternative medicine to
ensure our surgical candidates are provided exceptional care before and after their surgery.
- Our patients are seen 3 times per day with 24/7 coverage from our Pain Service team.
- Instead of consistently using opioids, we utilize an epidural before and after surgery to decrease the likelihood of persistent pain after
surgery and cut the risk of opioid dependence out.
- We are conducting ongoing research that will help us identify pre-operatively, the individual pain tolerance of each patient and any genetic
indicators of possible opioid dependence. As we pursue this research we hope to soon identify the medication that will be most effective for
patients and eliminate the likelihood of opioid addiction

Holistic Approach: At the request of our patient families, we utilize massage and energy therapies post-operatively to sooth patient pain and
increase relaxation.
- Recent research on over 500 patients was conducted and showed we were able to reduce pain scores and anxiety scores by 50% in
patients. We are also beginning to incorporate mindfulness and meditation to help calm and focus our patients.
- Mindfulness and meditation are rapidly growing and are even becoming a staple in a number of companies such as Google
www.mindful.org/google-searches/
For more information please visit www.cincinnatichildrens.org/pectus or call 513-803-0300.
Resources:
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Cincinnati Children’s Hospital. Innovations in the Management of Pectus Deformities – A Holistic Approach.
(2015, September 29). www.globalcastmd.com/library/details/innovations-in-the-management-of-pectus-deformities--a-holistic-approach
Malek M. Ventilatory and cardiovascular responses to exercise in patient with PE. Chest 2003; 124:870-82.
Neviere R. Cardiopulmonary response follow surgical repair. Euro J CT Surg 2011; 40:e77-82
Tandon, A., Wallihan, D., Lubert, A., Hor, K., Garcia, V., Taylor, M. The effect of right ventricular compression on cardiac function in pediatric pectus excavatum.
The Heart Institute, Cincinnati Children’s Hospital Medical Center. http://www.cincinnatichildrens.org/WorkArea/DownloadAsset.aspx?id=119884
Tang M. Improved cardiopulmonary exercise after Nuss. Euro J CT Surg 2011; 1-5.