Ángel Gabriel Vega-Artiles1, David Pérez2, Oscar Martel1, Alberto Cuadrado1, Alejandro Yánez1. 1. Department of Mechanical Engineering, University of Las Palmas de Gran Canaria, Las Palmas de Gran Canaria, Spain. 2. Department of Thoracic Surgery, Hospital Universitario Insular de Gran Canaria, Las Palmas de Gran Canaria, Spain.
Abstract
OBJECTIVES: To study the influence of sternal transection and costal chondrotomies on the stiffness and stresses in the rib cage of adult patients undergoing Nuss pectus excavatum procedure. METHODS: Four pectus excavatum models with different Haller indexes were created by parameterizing a 3D model of a rib cage obtained based on a computed tomography scan of a patient with no pectus deformity. Using the finite element method, insertion of intrathoracic bars into all models was simulated in 3 conditions, namely, non-intervened, transverse sternal section and costal chondrotomies. Stiffness, stress distribution and maximum stresses for each case were obtained and compared. RESULTS: Transverse sternotomy provided a reduction of 44% to 54% in the stiffness of the rib cage, depending on the Haller index analysed, while chondrotomies promoted a stiffness reduction of 70%. Stress distribution in the rib cage followed similar pattern for all the tested Haller index, but the maximum stress decreased by 36% when performing a transverse sternotomy, whereas when performing costal chondrotomies, it decreased by 47%. CONCLUSIONS: Computational results report that transverse sternotomy reduces appreciably the stiffness of the rib cage, while costal chondrotomies promote even a higher stiffness reduction. Thus, these surgical procedures could improve the clinical outcomes of adult patients undergoing a pectus excavatum repair.
OBJECTIVES: To study the influence of sternal transection and costal chondrotomies on the stiffness and stresses in the rib cage of adult patients undergoing Nuss pectus excavatum procedure. METHODS: Four pectus excavatum models with different Haller indexes were created by parameterizing a 3D model of a rib cage obtained based on a computed tomography scan of a patient with no pectus deformity. Using the finite element method, insertion of intrathoracic bars into all models was simulated in 3 conditions, namely, non-intervened, transverse sternal section and costal chondrotomies. Stiffness, stress distribution and maximum stresses for each case were obtained and compared. RESULTS: Transverse sternotomy provided a reduction of 44% to 54% in the stiffness of the rib cage, depending on the Haller index analysed, while chondrotomies promoted a stiffness reduction of 70%. Stress distribution in the rib cage followed similar pattern for all the tested Haller index, but the maximum stress decreased by 36% when performing a transverse sternotomy, whereas when performing costal chondrotomies, it decreased by 47%. CONCLUSIONS: Computational results report that transverse sternotomy reduces appreciably the stiffness of the rib cage, while costal chondrotomies promote even a higher stiffness reduction. Thus, these surgical procedures could improve the clinical outcomes of adult patients undergoing a pectus excavatum repair.
Authors: Sara C Neves; A C M Pinho; Jaime C Fonseca; Nuno F Rodrigues; Tiago Henriques-Coelho; Jorge Correia-Pinto; João L Vilaça Journal: Comput Methods Biomech Biomed Engin Date: 2014-01-16 Impact factor: 1.763
Authors: David Pérez; Oscar Martel; Alejandro Yánez; José R Cano; Alberto Cuadrado; Gara Torrent; Luis López Journal: Interact Cardiovasc Thorac Surg Date: 2020-01-01
Authors: Sergio B Sesia; Margarete Heitzelmann; Sabine Schaedelin; Olaf Magerkurth; Gregor J Kocher; Ralph A Schmid; Frank-Martin Haecker Journal: Ann Thorac Surg Date: 2018-09-29 Impact factor: 4.330