Research and Publications

In the years since Dr. Donald Nuss developed a groundbreaking minimally invasive surgery to correct pectus excavatum – a deformity that causes the chest to collapse inward creating an indentation -- Children’s Hospital of The King’s Daughters has performed well over 1,000 surgeries for the condition, far more than any center. Because of the number of patients treated and the data gathered, CHKD has also become a worldwide center for pectus research.

Below are some of the articles published by CHKD-affiliated surgeons, geneticists, radiologists, often in collaboration with resident physicians and researchers affiliated with Eastern Virginia Medical School, CHKD’s academic partner.

Note: Click on the highlighted link to read the abstract

August 2008

Seminars in Pediatric Surgery, Volume 17, Issue 3. (August 2008)
Chest Wall Deformities
In recognition of their critical roles in developing cutting-edge treatment of chest wall deformities such as pectus carinatum and pectus excavatum, the journal Seminars in Pediatric Surgery tapped CHKD Surgeons Dr. Donald Nuss and Dr. Robert Kelly to edit an August, 2008, issue focusing on surgery to correct the anomalies. Nuss and Kelly recruited surgeons to author the articles and edited the entire journal. They also wrote a preface and two articles, Pectus Excavatum: Historical Background, Clinical Picture, Preoperative Evaluation and Criteria for Operation by Kelly and Minimally Invasive Surgical Repair of Pectus Excavatum by Nuss.


August 2007

Journal of American College of Surgeons: Volume 205, Issue 2 (August 2007)
Prospective Multicenter Study of Surgical Correction of Pectus Excavatum: Design, Perioperative Complications, Pain, and Baseline Pulmonary Function Facilitated by Internet-Based Data Collection
Given widespread adoption of the Nuss procedure, researchers thought it would be valuable to examine and compare the results of pectus correction at various centers around the nation. They compared results in 327 patients treated at 11 centers in North America. Of those patients, 284 underwent the Nuss procedure and 43 had the open surgery that was the previous standard of care. While the small number who had the older procedure made meaningful comparisons between the two groups impossible, the case review confirmed that pectus patients overall showed depressed lung function before the surgery and that the surgical techniques developed by Nuss were safe and effective.
CHKD-affiliated authors: Donald Nuss, Robert Kelly, Michael Goretsky and nurse Traci Bagley

July 2007

The Japanese Journal of Thoracic and Cardiovascular Surgery:
Recent experiences with minimally invasive pectus excavatum repair “Nuss procedure”
With the Nuss procedure becoming more common in Japan, the Japanese Journal of Thoracic and Cardiovascular Surgery published an article by Dr. Nuss on techniques and outcomes in 688 cases.
CHKD-affiliated authors: Donald Nuss

August 2006

Journal of Pediatric Surgery: Volume 40, Issue 8 (August 2005)
Pectus excavatum in a 112-year autopsy series: anatomic findings and the effect on survival
Researchers based at CHKD performed a computer-assisted examination of 50,496 autopsies conducted at Johns Hopkins Hospital over a 112-year period and found evidence of pectus excavatum in 62 patients. Although a subset of pectus patients who lived beyond 56 years of age tended to outlive matched counterparts, pectus patients overall tended to die younger.
CHKD-affiliated authors: Robert Kelly

October 2006

Journal of Pediatric Surgery, Volume 41, Issue 10 (October 2006)
Family study of the inheritance of pectus excavatum
CHKD clinicians reviewed 34 cases of pectus excavatum and confirmed anecdotal observations that many cases appear to have a genetic basis. They also observed other disorders – and Ehlers Danlos syndrome – that often occur along with pectus excavatum, as well as benign physical traits such as long arms and legs and high-arched palates.
CHKD-affiliated authors: Donald Nuss, Robert Kelly, Michael Goretsky, Virginia Proud and Karen Mitchell.

September 2006

Journal of Pediatric Surgery: Volume 41, Issue 9 (September 2006)
Classification of the dysmorphology of pectus excavatum
CHKD researches, surgeons and nurses examined the case files and clinical findings in 64 pectus patients to gather epidemiological information such as the incidence in males and females, the age the problem presented itself and the different forms of the condition, including the length, shape and the location of the depressed portion of the chest.
CHKD-affiliated authors: Donald Nuss, Robert Kelly, Michael Goretsky, geneticist Virginia Proud and nurse Karen Mitchell.

July 2006

Journal of Pediatric Surgery: Volume 41, Issue 7 (July 2006)
Reliability of a standardized protocol to calculate cross-sectional chest area and severity indices to evaluate pectus excavatum
Surgeons must evaluate all patients with pectus excavatum to determine if the case is serious enough to warrant surgery. In this paper, surgeons demonstrate that a protocol developed at CHKD to evaluate prospective pectus patients is as useful as a standard evaluation regimen used by surgeons at other hospitals.
CHKD-affiliated authors: Donald Nuss, Robert Kelly, Michael Goretsky

January 2005

Journal of Pediatric Surgery, Volume 40, Issue 1 (January 2005)
Impact of pectus excavatum on pulmonary function before and after repair with the Nuss procedure
While post-operative pectus patients have reported increases in exercise tolerance, no laboratory study confirmed improved physical capabilities in patients who have undergone the Nuss procedure. This study uses pulmonary function tests to document increased lung function in patients after pectus surgery.
CHKD-affiliated authors: Donald Nuss, Robert Kelly, Michael Goretsky

October 2004

Adolescent Medicine Clinics, Volume 15, Issue 3 (October 2004)
Chest wall anomalies: pectus excavatum and pectus carinatum
Nuss and CHKD surgeons discuss the formation of chest wall deformities such as pectus excavatum and pectus carinatum, offering additional evidence that the pectus excavatum is more than a cosmetic anomaly.
CHKD-affiliated authors: Donald Nuss, Robert Kelly and Michael Goretsky

June 2003

Pediatric Surgery, Volume 38, Issue 6 (June 2003)
A pilot study of the impact of surgical repair on disease-specific quality of life among patients with pectus excavatum
To address a common perception that pectus excavatum was largely a cosmetic problem, a team of surgeons and researchers interviewed 22 patients and their parents before and after surgery and documented reports of increased exercise tolerance, decreased shortness of breath and fewer incidents in which patients reported feeling tired, sad, frustrated or isolated.
CHKD-affiliated authors: Donald Nuss, Robert Kelly and Michael Goretsky

January 2002

Cirugia Pediátrica, Enero 2002, Volume 15 (1) (Publication of the Spanish Society of Pediatric Surgeons)
Reparación mínimamente invasiva del pectus excavatum (“Minimally invasion repair of pectus excavatum”)
With the Nuss procedure growing popular around the world, the Spanish Society of Pediatric Surgery published and translated an article by Nuss on the new technique.
CHKD-affiliated authors: Donald Nuss

January 2001

Pediatric Radiology, Volume 31, Number 6 / May, 2001
Radiologic considerations in patients undergoing the Nuss procedure for correction of pectus excavatum.
Correction of pectus excavatum using the Nuss technique involves not just the surgeon but a complete medical team, including the radiologists who evaluate the severity of the cases and also the extent of the correction. In this study, Nuss and CHKD radiologists present techniques they’ve developed to evaluate the surgical, pulmonary and cardiac functions of patients before and after surgery.
CHKD-affiliated authors: Donald Nuss

February 2000

Journal of Pediatric Surgery: Volume 35, Issue 2 (February 2000)
“Outcome analysis of minimally invasive repair of pectus excavatum: Review of 251 cases” By 2000, the minimally invasive surgical techniques for pectus excavatum developed by Dr. Donald Nuss had grown increasingly common, but no published studies had documented the outcomes with a large number of patients. In this study, Nuss and a team of surgeons from around the nation analyzed the outcomes in 251 cases.
CHKD-affiliated authors: Donald Nuss

Results and Outcomes

Patients undergoing surgery are monitored on an ongoing basis through our database in order to provide information on early results as well as on long-term outcomes.

For more information about pectus excavatum research at CHKD, contact Amy Quinn at 866-279-6430.