Thoracic surgeons Dennis Wigle, M.D., Ph.D. , and Janani S. Reisenauer, M.D. , speak to how Mayo Clinic uses a multidisciplinary, team approach to treat patients diagnosed with pectus excavatum. This collaborative environment inspires innovative techniques, such as 3D printing and imaging, to predict cosmetic outcomes and ensure precise bar placement to improve patient outcomes postoperatively.
Adult practice excavate them is one of the most common congenital chest wall deformities and it occurs in about one in 200 live births with a predominance in males. It oftentimes can be detected right at birth but often doesn't bring attention to itself until the child is going through adolescence because that's when certain features such as exercise intolerance or cosmetic defects might really bring themselves to light and the child might really become more aware and more conscious of it in terms of referral for patient evaluation. I think from our perspective, it's the situation where someone's symptoms really can't be explained by the more common things that can happen to the heart. So for example, the, you know, the valvular function is normal, the myocardial function is normal. There's no obvious underlying lung disease. And so frequently we see situations where all of the routine, more common stuff has really had a good look and without a clear answer as to why the patients experiencing what they are and that's really where it's an appropriate point to really take a deeper look for somebody who's either got a known practice or maybe where there's even a question of having a practice or the degree of it in terms of whether that's really a positive factor for someone experiencing what they are. We work in a very multidisciplinary fashion, both with our pain team, our pediatric surgical colleagues, but also recently with radiology. We work in very close association with our 3D, an atomic printing lab and we've currently designed a mechanism where we take the patient's CT scan and incorporate it into a model that allows us to predict what placing that bar would ultimately result in in terms of the patient's postoperative cosmetic appearance, the contour of the bar that we're actually bending under sterile conditions in the bar with the patient on the table. Can be done guided by the imaging in order to try and and have something as matched as best we can to that patient's defect. So the pain management for for practice is really one of the critical parts. It's really important that someone is in a position where they're comfortable enough to be able to get up, walk around deep breathe cough. And that's not only critically important in the hospital early when they're recovering from the procedure. But also those first few weeks or months that they're at home and having an individualized treatment plan for their pain management so they really can get on with their life with bars in place while we're waiting for their chest wall to remodel and really be in a position to safely take them out Across all of our three sites. We are the largest volume practice institution, certainly for adults in the country. And there's tremendous benefit that comes from that in order to be able to do the procedure, do it well, do it with a low complication rate and really get the result that everybody's looking for
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