THE TREATMENT OF PECTUS EXCAVATUM WITH THE VACUUM BELL AND RELATED PAIN MEDICATION AFTER SURGERY FOR CONGENITAL HEART DISEASE

Jingjing Zhang^1,2,3,4, Derong He^1,2,3,4*, Jinxi Huang^1,2,3,4, Junjie Hong^1,2,3,4, Songming Hong^1,2,3,4

¹Fujian Key Laboratory of Women and Children’s Critical Diseases Research, Fujian Maternity and Child Health Hospital, Fuzhou, 350000, China - ²Department of Cardiac Surgery, Fujian Maternity and Child Health Hospital, Affiliated Hospital of Fujian Medical University, Fuzhou, 350000, China - ³Department of Cardiac Surgery, Fujian Children’s Hospital, Fuzhou, 350000, China - ⁴Department of Cardiac Surgery, Fujian Branch of Shanghai Children’s Medical Center Affiliated to Shanghai Jiaotong University School of Medicine, Fuzhou, 350000, China

Secondary pectus excavatum (PE) after surgery for congenital heart disease (CHD) has its own clinical characteristics. Conservative treatment of PE with a vacuum bell (VB) device is an attractive alternative to surgical repair, and medication can be used to manage the pain and anxiety of children with PE after major CHF surgery. We use this device to treat pediatric patients with PE after heart surgery and share our experience. We conducted a retrospective study of all patients who had PE after surgery for CHD with median sternotomy from March 2019 to December 2020. A suction cup is used to create a vacuum at the anterior chest wall with a patient-activated hand pump. The size of VB is designed based on the patient’s anterior chest wall. To control patients' pain, Acetaminophen 15 mg / kg was prescribed and the amount of pain after the intervention was assessed. Fourteen patients (3/2019–12/2020) were conducted in this retrospective study in the clinic, and 9 patients (64.29%) achieved excellent correction (3D-DE≤3mm). The Fourteen patients were distributed into five stages (stage 1: before treatment, stage 2: treated for 3 months, stage 3: treated for 6 months, stage 4: treated for 9 months, and stage 5: treated for12 months). We found statistically significant differences in the 3D-DE and 3D-HI between stage 2 and stage 1(3D-DE p< 0.01, 3D-HI p< 0.01), stage 3 and stage 2(3D-DEp< 0.01, 3D-HI p< 0.01), and stage 4 to stage 3(3D-DEp< 0.01, but 3D-HI p>0.01), and stage 5 to stage 4(3D-DEp< 0.01, but 3D-HI p>0.01). The main side effects were moderate subcutaneous hematoma, petechial bleeding, thoracalgia, and chest tightness. There were no children complicated with hydropericardium or cardiac tamponade. Pain after sternotomy has also been controlled with acetaminophen in these patients. The VB has been shown to be a safe and effective approach for the treatment of PE after surgery for CHD. We suggest that the treatment should be gradual, so as to prevent tearing of the heart where adhere to the substernal.