Patients and Methods

Thirty-four patients (31 males, 3 females), aged from 6 to 52 years (median 17.8 years, Fig. 3 ) were treated with the vacuum bell for 1 to a maximum of 18 months (median 10.4 months). For further evaluation, patients were divided into two groups. Group 1 included 23 paediatric patients aged ≤18 years. Group 2 comprised 11 adult patients aged from 19 to 52 years (Fig. 3). Standardised evaluation before starting the procedure included 3D computerised tomography (CT) scan, pulmonary function tests, cardiac evaluation with electrocardiogram and echocardiography and photo documentation. In addition, the depth of PE was measured. Patients underwent follow-up at 3–6 monthly intervals including photography and clinical examination.

The first application of the vacuum bell occurred under supervision of the attending doctor. The length of time of daily application of the vacuum bell varied widely between patients. Patients were told to follow the user instructions applying the device twice daily for 30 min each. In fact, the duration and frequency of daily application depends on the patients individual decision and motivation. One patient, a 52-year-old businessman, used the vacuum bell 4–6 h daily during office hours. Two adolescent boys applied the device every night for 7–8 h. A 21-year-old male patient, who underwent PE repair by the Ravitch procedure 6 years ago, was dissatisfied with the postoperative result and recently started treatment with the vacuum bell. In addition to the daily application of the device, all patients were recommended to carry on undertaking physiotherapy as well as sports, e.g. swimming. Physical fitness, especially chest fitness with well developed pectoralis major muscle did not hinder the correction in anyone of our patients.