{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T07:20:27Z","timestamp":1784704827221,"version":"3.55.0"},"reference-count":19,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2024,4,2]],"date-time":"2024-04-02T00:00:00Z","timestamp":1712016000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Pediatr."],"abstract":"<jats:sec><jats:title>Introduction<\/jats:title><jats:p>International research suggests that poor patient compliance is the main cause of tutor failures in the context of potential novel orthopedic bivalve braces for conservative treatment of pectus carinatum. Our entire experimental study is based on the hypothesis that a rigid bivalve brace that patients can accept could solve the main problem associated with the conservative approach\u2014poor compliance. The hypothesis was to reduce the thickness and weight of the classic bivalve brace to ensure concealment and make it sustainable enough to be worn several hours a day without compromising its therapeutic efficacy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Materials and method<\/jats:title><jats:p>The research was conducted from January 2020 to December 2022 to ensure follow-up of all participants for at least 6 months. In 36 months, 140 patients with pectus carinatum were assessed and conservatively treated with the studied guardian to analyze the therapeutic efficacy of the bivalve brace and patient compliance. From the initial visit, the parents and patient were informed that this is a 2-year therapeutic course during which the bivalve brace should be worn at least 23\u2005h a day (with 1\u2005h of abstinence per day for routine personal hygiene practices). Compliance is the key to therapy success, and the duration of treatment depends on patient adherence.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The exceptional effectiveness of the experimental brace was confirmed by both the questionnaire from the patients (with an average satisfaction rate of 8.9\/10) and an assessment of the therapy's results by a properly selected medical committee (with a VAS scale satisfaction of 7.2\/10 for symmetric forms and 7.1\/10 for asymmetric ones).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In conclusion, the analyzed data confirmed the research hypotheses. First, none of the 140 patients had cardiovascular diseases directly related to their condition, confirming that pectus carinatum is a pathology of a purely aesthetic nature. Second, a cheap, lightweight, and easily obscured brace significantly improved patient compliance. Along with this, the social relevance of the aesthetic aspect today may be an important factor in motivating the study cohort to adhere to therapy. In the past, esthetics and appearance were less relevant at the social level, which may have contributed to the high abandonment and reduced compliance rates of the many studies in the literature.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fped.2024.1321633","type":"journal-article","created":{"date-parts":[[2024,4,2]],"date-time":"2024-04-02T05:05:00Z","timestamp":1712034300000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["A new custom-made bivalve brace for pectus carinatum in children and adolescents: preliminary promising experience of 140 patients from a tertiary center"],"prefix":"10.3389","volume":"12","author":[{"given":"Simone","family":"Frediani","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Angelo","family":"Zarfati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valerio","family":"Pardi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ivan","family":"Aloi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arianna","family":"Bertocchini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Antonella","family":"Accinni","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Federico","family":"Beati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimiliano","family":"Pasanisi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Inserra","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2024,4,2]]},"reference":[{"key":"B1","first-page":"167","article-title":"Considera\u00e7\u00f5es sobre deformidades da parede tor\u00e1cica anterior e apresenta\u00e7\u00e3o de tratamento conservador para as formas com componentes de protrus\u00e3o","volume":"14","author":"Haje","year":"1979","journal-title":"Rev Bras Ortop"},{"key":"B2","doi-asserted-by":"publisher","first-page":"194","DOI":"10.1053\/j.sempedsurg.2008.03.008","article-title":"Dynamic compression system for the correction of pectus carinatum","volume":"17","author":"Martinez-Ferro","year":"2008","journal-title":"Semin Pediatr Surg"},{"key":"B3","doi-asserted-by":"publisher","first-page":"138","DOI":"10.1016\/S0096-5588(20)31203-4","article-title":"Unusual sternal deformity with cardiac symptoms operative correction","volume":"23","author":"Ravitch","year":"1952","journal-title":"J Thorac Surg"},{"key":"B4","doi-asserted-by":"publisher","first-page":"691","DOI":"10.1016\/S0022-5223(19)32839-9","article-title":"The surgical treatment of chondrosternal prominence (pectus carinatum)","volume":"45","author":"Robicsek","year":"1963","journal-title":"J Thorac Cardiovasc Surg"},{"key":"B5","first-page":"326","article-title":"Surgical repair of pectus carinatum","volume":"84","author":"Saxena","year":"1999","journal-title":"Int Surg"},{"key":"B6","doi-asserted-by":"publisher","first-page":"659","DOI":"10.1016\/0022-3468(73)90404-1","article-title":"Surgical correction of pectus carinatum (pigeon breast)","volume":"8","author":"Welch","year":"1973","journal-title":"J Pediatr Surg"},{"key":"B7","doi-asserted-by":"publisher","first-page":"471","DOI":"10.1016\/j.jpedsurg.2008.09.020","article-title":"Minimally invasive thoracoscopic repair of unilateral pectus carinatum","volume":"44","author":"Kim","year":"2009","journal-title":"J Pediatr Surg"},{"key":"B8","doi-asserted-by":"publisher","first-page":"263","DOI":"10.1016\/j.jpedsurg.2010.08.010","article-title":"Thoracoscopic cartilage resection with partial perichondrium preservation in unilateral pectus carinatum: preliminary results","volume":"46","author":"Varela","year":"2011","journal-title":"J Pediatr Surg"},{"key":"B9","doi-asserted-by":"publisher","first-page":"1099","DOI":"10.1016\/j.athoracsur.2005.10.042","article-title":"New endoscopic minimal access pectus carinatum repair using subpectoral carbon dioxide","volume":"81","author":"Schaarschmidt","year":"2006","journal-title":"Ann Thorac Surg"},{"key":"B10","doi-asserted-by":"publisher","first-page":"349","DOI":"10.1157\/13076004","article-title":"M\u00e9todo miniinvasivo para la correcci\u00f3n del pectus carinatum. 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