The relation of pectus excavatum to pectus carinatum; olassification of anterior chest wall deformities and the effect on treatment.
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To demonstrate the elimination of pectus excavatum and promotion of more normal lung growth and chest wall development by the use of high-span positive inspiratory pressure plus positive end-expiratory pressure (PIP+PEEP), patients with spinal muscular atrophy type 1 with paradoxical breathing were placed on high-span PIP+PEEP when sleeping from the point of diagnosis of spinal muscular atrophy. Although the appearance of pectus excavatum is ubiquitous in untreated infants with spinal muscular atrophy type 1, after institution of high-span PIP+PEEP, pectus resolves and lungs and chest walls grow more normally. High-span PIP+PEEP is indicated for all infants diagnosed with spinal muscular atrophy who demonstrate paradoxical breathing for the purpose of promoting more normal lung and chest development.
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An 18-year-old patient who had correction of pectus excavatum deformity in our department 4 years earlier was admitted because of stabbing chest pain. He had not attended to postoperative controls and had not come for extraction of the steel strut, although he had been contacted. He was diagnosed to have a broken steel strut, and the strut was noted to be embedded in the myocardium. This unreported complication of pectus excavatum operation forced us to review sternal support techniques.
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BACKGROUND: Coronary revascularization in patients with pectus excavatum is technically difficult through a median sternotomy secondary to the posterior displacement of the sternum and the asymmetric angulation that it produces. The role of minimally invasive coronary artery bypass grafting (MIDCABG) in this subset of patients was evaluated. METHODS: In 1998, four patients with pectus excavatum underwent revascularization of the left anterior descending artery without cardiopulmonary bypass through a left anterior minithoracotomy. RESULTS: All patients underwent the procedure without intraoperative complications and postoperative angiography demonstrated adequate graft patency. CONCLUSIONS: The advantages of MIDCABG in patients with pectus excavatum is the superior exposure to the LAD and LIMA and avoidance of a median sternotomy and cardiopulmonary bypass. This procedure is deemed safe and effective in patients with such deformities of the chest wall.
Two patients are presented who had open intracardiac procedures with simultaneous repair of pectus excavatum by sternal eversion or turnover. This method offered excellent exposure, relieved cardiac compression, maintained chest wall stability, and improved the appearance of the chest wall.
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The posteroanterior and lateral chest radiographs of 72 consecutive patients with sternal depression, together with 72 age- and sex-matched controls, have been reviewed. We assessed size and position of the cardiac silhouette, mediastinal contour, radio-opacity in the right lower zone and rib configuration. The degree of depression was determined from the lateral radiograph. The most significant signs of sternal depression on the posteroanterior chest radiograph are a straight left heart border, displacement of the cardiac silhouette to the left and an indistinct right heart border. These three signs have a high specificity for sternal depression and are significantly more commonly seen with increasing severity of depression. The presence of any three, or of more than three, of the described signs was 95.5% specific. However, despite this high specificity, the sensitivity and positive predictive value even for a combination of signs are low. Sternal depression is a relatively common chest deformity and the radiologist should be aware of the changes on the posteroanterior chest radiograph to avoid pitfalls in diagnosis.
Different chest deformations are accompanied by appearance of asbestos-like fibrills in pericellular matrix, development of significant lipid and carbohydrate chondrocyte dystrophy, irreversible changes in their majority. Anomalous accumulation of intermediate filaments, lipid and glycogen, may substitute the cytoplasm organells in Marfan's syndrome. Pathologic disturbances of costal cartilage, connected with ultrastructural changes of chondrocytes, intercellular substance and extracellular matrix are morphologic substrate of different chest deformations.