Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Funnel Chest”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 37 records · Page 2Linked to original sources
PubMed2005

Extrapleural, submuscular bars placed by bilateral thoracoscopy--a new improvement in modified Nuss funnel chest repair.

BACKGROUND: Thoracoscopic Nuss funnel chest repair still has a significant complication rate. Bar dislocation, pneumothorax, pleural effusions, and pericarditis seem to be caused mechanical irritation by the bar. We intended to reduce these problems by further technical modification of the Nuss technique. METHODS: Of 157 prospectively followed modified Nuss repairs, the last 57 patients had the bars placed in an extrapleural position and fixed by 10 to 14 pericostal sutures under bilateral thoracoscopy. RESULTS: Entirely, extrapleural bar position was feasible in 53 of 57 patients. Four patients had minor holes over one of the bars, predominantly on the left side of the thorax. Pleural effusions, pneumothorax, and pain were greatly reduced, so that we discontinued the so far routine use of bilateral pleural drainages. CONCLUSIONS: Extrapleural bar position is feasible in more than 90% of modified Nuss repairs. It reduces pleural secretion and pain, and seems to reduce pneumothorax, pulmonary bar adhesions, and pericardial effusions. The technique is easy and safe, and reduced the incidence of most complications in this early experience of 57 adolescent patients, although no sportive restrictions were imposed at all.

Adolescent↗
PubMed1999

Funnel chest. Psychological and psychosomatic aspects in children, youngsters, and young adults.

BACKGROUND: When considering the indications for operative correction of funnel chest, the first question is what is medically actually necessary, and what is founded simply on 'doctors opinion'. Furthermore symptoms are often only indirectly correlated with the basic illness. This paper suggests a possible way of objectivating the symptoms in 56 patients with funnel chest. METHODS: According to the results of our retrospective examinations the differentiation between 'physical' and (merely) 'cosmetic' findings in the definition of indications for operation of funnel chests in children, youngsters and young adults, should be dispensed with. The symptoms of "funnel chest" can be of varied significance, according to the degree of deformity, ranging from cosmetic fault to a severe handicap. Definition of indication thus depends in each case on all-inclusive plus differential plus interlocking-systemic diagnosis. In the course of this, not only somatic data, but also psychosocial characteristics can be objectivated and quantified. RESULTS: The results of our examinations show that the handicaps of a funnel chest influence all areas of life. Older children (over 11 years) display as a whole more psychological disorders. Along with specific embarassment reactions, social anxiety, feelings of stigma, limited capacity for work, orientation towards failure, reduced tolerance of frustration and temptation, limited capacity for communication and even markedly depressive reactions are observed. CONCLUSIONS: The underlying deformity and the psychological reactions to it make a long-term psychotherapy necessary. This may be laid out methodically more simply and takes less time, when a permanent correction is brought about at operation.

Adolescent↗
PubMed1987

Familial congenital funnel chest.

We observed three Chinese families in which congenital isolated funnel chest was segregating. This report confirms that funnel chest (pectus excavatum) can be transmitted as an autosomal dominant trait.

Funnel Chest↗
PubMed1984

[Phono- and echocardiographic studies of the genesis of mitral valve prolapse in patients with funnel chest].

Two-dimensional echocardiograms (2-DE) and phonocardiograms (PCG) were used to clarify the genesis of mitral valve prolapse (MVP) and mitral regurgitation (MR) in 44 patients with funnel chest. These patients were categorized in three groups on the basis of the fronto-sagittal index (FSI) as determined from chest radiographs; 17 as mild, 15 as moderate and 12 as severe funnel chest. Their ages ranged from 5 to 65 years and averaged 24 years. MVP was diagnosed using the long-axis view of the 2-DE, and MR was diagnosed phonocardiographically including provocative test using angiotensin II. The results were as follows: In 44 patients with funnel chest, 20 (45%) had MVP and 15 (34%) had MR, respectively. The incidence of MVP increased directly in proportion to the severity of index, but the incidence of MR did not. In the short-axis view of the left ventricle at the level of the papillary muscles, there was more marked flattening of the interventricular septum than of the left ventricular posterior wall, resulting in deformity of the left ventricular geometry. A distortion index (DI) was used to quantify the degree of distortion of left ventricular shape, calculated as follows: DI = (R-r)/r, where R and r were radii of the curvatures of the interventricular septum and the left ventricular posterior wall, respectively. The DI in end-diastole (DId) and end-systole (DIs) increased in proportion to the severity of funnel chest. Patients were subdivided into four groups on the basis of DId. Incidence of MVP increased in proportion to the degree of distortion of the left ventricular shape. There was, however, no significant difference in the incidence of MR among the four groups. Patients were subdivided; one group of 13 under 14 years of age; another, 31 over 15 years old. The incidence was much higher in the latter than the former, but the incidence of MVP increased in proportion to the severity of funnel chest in both groups. MR was complicated by MR in nearly all cases in the latter group, but none had MR in the former. The DI of patients, whose FSI improved with surgery, apparently improved in addition to the disappearance and/or improvement of their MVP and MR. However, patients whose FSI did not improve with surgery showed little change in DI and persistence of MVP and/or MR.(ABSTRACT TRUNCATED AT 400 WORDS)

Adolescent↗
PubMed1989

[Funnel chest: objective and subjective aspects].

Forty cases of funnel chests were observed in a majority of 15-20 years old male youngsters. Twenty-six had respiratory or cardiac symptoms. A surgical correction was done for 22 patients; 12 had symptoms. Eighteen patients had no surgery and were advised to undertake physical therapy: 6 had symptoms. With a 1 to 25 years follow-up 12 operated patients were checked up: 10 were satisfied with the correction. None had any symptom. This subjective results were superior to the morphologic and functional criteria. As for non operated patients, 12 were contacted: 7 had followed our advice and felt a functional amelioration in 6 cases and a morphological amelioration in 4 cases. Five patients had no therapy: 4 considered themselves in a stable situation an 1 thought it was worse. Funnel chest symptoms are the expression of anxiety in a majority of cases. The subjective as well as the formal matters are to be considered to appreciate the results of treatment. Physical exercises are an important part of the therapy, either with or without surgery.

Adolescent↗
PubMed1996

[Operative corrections of funnel chest depend on age group].

The methods of correcting funnel chest are various and many. It's necessary to select the proper method depending on the age group. For children, sternal elevation by Ravitch's procedure produces to better results without prosthesis. For adolescent patients, the elevated sternum can be maintained by Kirschner's wires. Furthermore, adult patients have severe chest wall deformities with calcificated costal cartilage. The methods sternal elevation methods cause an unsatisfactory by postoperative appearance for adult patients with funnel chest. Two adult patients, 20 and 48-year-old men, underwent the sternal turnover methods with complete sternal blood supplies. The procedures of the new method turn over the sternal body crossing bilateral internal thoracic vessels and abdominal rectal muscles. No chest wall deformities were seen and the patency of internal thoracic arteries and superior epigastric arteries was revealed by postoperative arteriography.

Adolescent↗
PubMedDate not supplied

[Objective determination of the shape of the anterior chest wall using moiré topography. Method and development of dimension-free indices for the evaluation of funnel chest].

Stereophotogrammetric measurement of body surface results in data, which are dependent on shape, posture and positioning of the patient. In order to establish a valid description and characterization of funnel chest measured by stereophotogrammetric methods, index numbers must be defined, which are independent of posture und positioning of the patient. This procedure is exemplified in the analysis of moiré topograms from 29 patients with funnel chest and 21 normal persons. The sagittal cross section is characterized by the index TI I, which in essential is the sum of absolute values of angles in a polygon along the section (cf. fig. 7). The funnel in the coronal cross section is characterized by the index TI II, which gives the quotient (in %) of the mean funnel width and funnel depth (cf. fig. 8). Application of the index numbers shows a good differentiation of TI I, independent of sex, whereas TI II might be most useful in follow up measurements.

Adolescent↗
PubMed1997

[Simultaneous repair for funnel chest and intracardiac lesions in two pediatric patients].

Two successful cases underwent simultaneous repair for funnel chest using sternal turnover with rectus abdominal flap and intracardiac lesions were reported. A 7-year-old female (case 1) was diagnosed with funnel chest and annulo-aortic ectasia due to Marfan's syndrome. Second patient was a 12-year-old male (case 2) with funnel chest and ventricular septal defect (VSD). Both patients underwent sternal turnover and intracardiac repair (case 1: Bentall's operation, case 2: patch closure of VSD), simultaneously. Removing the cost-sterno complex before cardiac operation allowed an excellent surgical exposure. Bleeding was minimum, especially no homologous blood transfusion was needed in case 2. Simultaneous surgery consisted of intracardiac repair and sternal turnover is recommended even for pediatric patients.

Aortic Valve Insufficiency↗
PubMed1992

[Techniques and experiences in funnel chest operations].

Hegemann's technique of funnel chest correction using transsternal metal bar stabilization was adapted from the method published by Sulamaa and coworkers in 1958. Until the end of 1991, about 2400 chest wall corrections were performed in our department, more than 2000 of them using modifications of the original method. The principles of external chest wall measurement, our classification method, and the current operative modifications are described. In long-term follow-up examinations less than 3% recurrences should be possible.

Adolescent↗
PubMed1975

[Surgical treatment of funnel chest. Surgical experience with 90 cases].

Funnel chest, a congenital hereditary deformity, may lead to impairment of cardio-pulmonary function. The predominant motives for operation are psychological and cosmetic. Minor deformities amenable to physiotherapy should not be operated on, but moderately severe one represent a justified surgical indication. Objective photographic documentation is essential. Because of their bearing on surgical technic and results the symmetrical, asymmetrical, localized and extensive deformities should be distinguished. 90 operations have been performed between 1951 and 1974 according to the different known technics published during that period. Results were irregular until the introduction, eight years ago, of an operation combining extensive resection, by the method of RAVITCH, and stabilization by a metal strut as recommended by ADKINS et al. 24 operations performed during the last eight years have afforded perfect long term results.

Adult↗
PubMedDate not supplied

[Surgical treatment of funnel chest].

In 1976-1985, 39 patients were operated for the funnel chest. All patients were enrolled for the intensive rehabilitation program in the hospital, and correction exercises followed by swimming were recommended after release home. A favourable cosmetic effect was achieved in all patients in early postoperative period. However, a recurrence of the funnel chest has been noted in 10 patients (26%), later. Abnormality has been less advanced except 1 patient in whom subjective worsening has been noted.

Adolescent↗
PubMed1993

[A case of abortive malignant hyperthermia during funnel chest surgery].

We experienced a case of abortive malignant hyperthermia during funnel chest surgery. Although a 5-year-old boy had muscle rigidity after the intravenous injection of succinylcholine chloride, the tracheal intubation was easy. The boy had high body temperature, metabolic acidosis, hyperkalemia and myoglobinuria during nitrous oxide-oxygen-sevoflurane anesthesia. We immediately came to the diagnosis of abortive malignant hyperthermia, gave intravenous injection of dantrolene sodium and started body surface cooling. Postoperative course was uneventful. It is necessary to pay a particular attention to possible malignant hyperthermia in patients with funnel chest surgery.

Anesthesia, General↗
PubMed2003

Indications for surgical repair of funnel chest based on indices of chest wall deformity and psychological state.

PURPOSE: We examined the surgical indications for funnel chest, taking psychological factors into consideration. METHODS: We assessed 36 young people with funnel chest who were seen as outpatients, including 31 boys and 5 girls aged from 1 to 22 years old. Respondents were asked whether they suffered psychological distress, and if they wanted surgery. The severity of the deformity was evaluated using the Vertebral Index (VI) and the Frontosagittal Index (FSI) calculated from chest roentgenograms. RESULTS: The VI in 11 patients without distress (23.7 +/- 4.1) was lower than that in 25 patients with distress (32.8 +/- 8.2), and the FSI in the patients without distress (33.5 +/- 5.3) was higher than that in the patients with distress (23.6 +/- 8.6). The VI in 19 patients who did not want surgery (26.9 +/- 7.9) was lower than that in 17 patients who did (33.5 +/- 7.5), and the FSI in the patients who did not want surgery (30.4 +/- 8.1) was higher than that in the patients who did (22.4 +/- 8.1). The distressed patients suffered many psychological problems, such as being the object of bullying. CONCLUSION: The severity of the deformity affected the patient's psychological state. We consider that a VI >28 or an FSI <28 are indications for surgery, based on the mean VI + SD and the mean FSI-SD of patients not suffering distress.

Adolescent↗
PubMed2001

Indications for surgical treatment of funnel chest by chest radiograph.

Forty-seven children with funnel chest (FC) who underwent sternal elevation and 210 normal children were examined to determine the indications for surgical treatment using the vertebral index (VI) and frontosagittal index (FSI). In normal children VI gradually increased and FSI gradually decreased with age. Both indices changed significantly at 3 years of age. Although the VI of FC patients decreased significantly from 33.8 +/- 7.6 (n=40) to 24.4 +/- 3.9 (n=38) postoperatively (P < 0.0001), it was significantly larger than that of normal children over 3 years of age (20.2 +/- 2.2, n=150) (P < 0.0001), and although the FSI of FC patients increased significantly from 22.0 +/- 7.0 (n=40) to 34.5 +/- 6.5 (n=38) postoperatively (P < 0.0001), it was significantly smaller than that of normal children over 3 years of age (41.1 +/- 4.0, n=150) (P < 0.0001). Since many patients had a thin and flat chest despite excellent correction, their postoperative indices were not normal. There was a correlation between VI and FSI in normal children and a high degree of correlation between VI and FSI both before and after operation in FC patients. We conclude that a VI of more than 27 and/or a FSI of less than 29 are indications for surgical treatment based on the mean VI + 3SD and FSI - 3SD of normal children over 3 years of age. These values are almost equal to the mean VI - SD and FSI + SD of patients with physical, cosmetic, and/or psychological disturbances. However, it is not necessary to measure both indices simultaneously. Postoperative VI and FSI did not always reflect the degree of chest-wall depression in FC patients because of their flat chests.

Adolescent↗
PubMed2001

Funnel chest: treatment strategy and follow-up.

Although funnel chest is the most frequently seen deformity of the anterior chest wall in children, there is still considerable controversy regarding three major aspects, namely, the frequency of such deformities, their physiological importance, and the methods available for treatment. We retrospectively analyzed our experience with the 154 patients managed in our department. In 81 of these an operation was performed (OP), and the clinical findings for this group were compared with the 73 patients in whom an operation was not performed (NOP). Evaluation included subjective findings, especially the views of the patients' parents, and objective findings, including chest radiographs, computed tomography (CT), spirogram, electrocardiography, and echocardiography. In all patients the assessment included postoperative respiratory symptoms, appearance of the chest, and psychological aspects related to the deformity. Post-operatively, respiratory symptoms almost invariably subsided. The cosmetic result could initially be regarded as satisfactory or fair during the first 10 years following surgery, but over time there was frequently increasing concern regarding the scar. The NOP patients showed significantly less severity of the funnel index compared with OP patients. However, there was no spontaneous improvement in the deformity in older patients; most of the NOP patients continued to show a cosmetic deformity and 26.7% had psychological problems. This retrospective study confirms that our treatment strategy of objective criteria for operation (functional compression index > 0.2, % vital capacity <80, and CT index less than 0.25) and timing of operation (between 4 and 6 years of age) provides good results. Based on the analysis of long-term follow-up, surgery is considered indicated in patients with severe deformity. However, in the interest of psychological development, the indications for surgery may be extended.

Abnormalities, Multiple↗
PubMedDate not supplied

Minimally-invasive endoscopic correction of funnel chest deformity via an umbilical incision.

Congenital funnel chest deformities (pectus excavatum) are a well known condition that may require surgical correction if repercussions on the respiratory and cardiac dynamics are caused by the compression on the mediastinal structures and by the reduction of the respiratory volume. However, the aesthetic defect may have serious psychological implications and-even if no respiratory impairment is caused-may nevertheless indicate aesthetic correction by implanting a custom-made prosthesis. Alloplastic correction traditionally results in long, visible scars. Since the presternal area is prone to hypertrophic scarring, this type of scar may be a disturbing complication of the intervention. Endoscopically-assisted minimally-invasive implantation of customized implants via an umbilical incision to introduce a customized single-unit silicone implant can avoid unsightly scarring and allows safe hemostasis in the dissection pocket, minimizing well-known side effects and patient morbidity.

Adult↗