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At least 721 records · Page 40Linked to original sources
PubMed1980

Surgical correction of pectus excavatum and carinatum.

This paper contains an analysis of the long-term results in 85 patients who had pectus excavatum or carinatum deformities repaired at the North Middlesex Hospital between 1951 and 1977. Seventy-seven patients had operations for correction of pectus excavatum and eight for pectus carinatum. A variety of surgical techniques was used. In the excavatum deformities the best results were obtained by the extensive resection of all deformed cartilages, the correction of the sternal deformity by a simple transverse wedge osteotomy, and by stabilising the chest with a stainless steel plate. For pectus carinatum, the involved cartilages were resected and an osteotomy of the sternum was performed. We preferred in most cases to stabilise the chest wall with a metal strut in this deformity as well. The best cosmetic results were achieved by the use of a stainless steel plate passed beneath the sternum and left for not more than six months.

Adolescent↗
PubMed2000

Modified sternal elevation for children with pectus excavatum.

OBJECTIVE: To describe our experience in the treatment of pectus excavatum (PE) using a modified sternal elevation procedure. METHODS: From Oct. 1986 to Dec. 1997, 171 patients with PE were admitted to the Department of Pediatric Surgery of the First Hospital of West China University of Medical Sciences. All patients were diagnosed through a history and physical examination. Cardiopulmonary function was assessed by M-mode echocardiography and instrument of pulmonary function in 40 patients before and 4.2 years after surgery which was performed between 1989 and 1994. We performed the following three procedures in the sternal elevation: (1) forming the metal strut in a "arch" shape, (2) suturing the perichondrium into a "pipe" shape, and (3) encouraging patients to do chest expansion exercise after operation. All patients were followed up for 1 to 12 years. RESULTS: The normal contour of the costal cage was enlarged in all but one patient. Exercise tolerance was improved, and cardiac function recovered to the same level as in healthy children, while pulmonary function recovered very slowly after surgery. CONCLUSION: The normal appearance of chest wall can be recovered and normal cardiopulmonary function can be restored by the modified sternal elevation procedure in children with PE.

Adolescent↗
PubMedDate not supplied

Chest wall deformities.

Children present with chest wall deformities to their pediatrician because of physiologic and psychologic causes. We have a 22-year experience in the operative management of more than 300 of these children. Initial evaluation should accurately categorize the deformity, determine the severity, assess for associated problems and refer the child at an appropriate time for further management. Pectus carinatum is the most common deformity that can cause physical pain from an intercostal neuropathy and psychologic pain from the unsightly protuberance. Poland syndrome is managed by early correction of the hand deformity and later correction of the chest wall deformity if necessary for psychologic or functional reasons. Jeune syndrome and failure of sternal fusion may have severe associated cardiopulmonary compromise. Each should be corrected in infancy for the best results.

Adolescent↗
PubMed1983

Correction of bilateral breast hypoplasia and pectus excavatum with single-unit customized silicone implant.

The cosmetic defects of pectus excavatum and bilateral mammary hypoplasia can be corrected with a single-unit customized silicone implant. An extended pocket is made across the anterior chest wall through two inframammary incisions. It is then possible to insert and position the breast prostheses subpectorally and the sternal prosthesis subcutaneously using these incisions. A good cosmetic result can occur with minimal morbidity and scarring.

Adult↗
PubMed2006

Recent experience with open repair of pectus excavatum with minimal cartilage resection.

HYPOTHESIS: Inconsistent results have been reported using a variety of open surgical techniques to correct pectus excavatum (PE) deformities with subperiosteal resection of deformed costal cartilages. DESIGN: Retrospective 6-year review of 450 consecutive patients undergoing PE repair. SETTING: Tertiary care academic medical center. PATIENTS: Symptomatic patients with severe PE (severity index >3.4). INTERVENTION: Evaluation of open repair with minimal cartilage resection, suture reattachment of costal cartilages to the sternum and ribs, and internal support strut for 6 months. MAIN OUTCOME MEASURES: Age at repair, severity index, reduction of symptoms, complications, recurrence, and mortality. RESULTS: Nine percent of patients were younger than 12 years at repair, 42% were aged 12 to 17 years, 33% were aged 18 to 30 years, and 16% were older than 30 years. Nineteen percent were female. Mean +/- SD severity index was 4.88 +/- 1.8. Mean hospital stay was 2.9 days. No patients received epidural analgesics. Complications occurred in 2.6% of patients and included idiopathic ventricular arrhythmia (2 patients), transient pericarditis (2 patients), pleural effusion (3 patients), dislodged sternal bar (2 patients), hematoma (1 patient), seroma (1 patient), and localized infection (1 patient). Mild recurrence occurred in 4 patients, and 9 patients had resection of localized cartilage protrusion when the bar was removed. There were no deaths. Ninety-eight percent of patients reported very good to excellent results. All patients reported improvement in symptoms. Mean follow-up was 26 months after strut removal. CONCLUSION: In this largest, to our knowledge, recently reported series of openly repaired PE using minimal cartilage resection and suture reattachment of the costal cartilages to the sternum and ribs, advantages included short operative time, stable early postoperative chest wall, few complications, mild pain, good physiologic and cosmetic results, and effectiveness for all variations of PE in patients of all ages.

Adolescent↗
PubMed1999

Repair of pectus excavatum and carinatum in adults.

BACKGROUND: There is sparse published information regarding the repair of pectus chest deformities in adults. This report summarizes our clinical experience with the surgical repair of pectus excavatum and carinatum deformities in 25 adults. METHODS: During the past 11 years, 25 patients 20 years of age or older (mean 31) with symptomatic pectus excavatum (23) or carinatum (2) deformities underwent surgical repair using a temporary internal sternal support bar. RESULTS: Each of the patients with decreased stamina and endurance or dyspnea with exercise experienced marked clinical improvement within 4 months postoperation. Exercise-induced asthma was improved in 6 of 7 patients; chest pain was reduced in each of 9 patients. Postoperative complications included pneumothorax (1), keloid (2), and discomfort from sternal bar (2). The sternal bar was removed 7 to 10 months postoperation in 19 patients; there has been no return of preoperative symptoms or recurrent depression in any patient with a mean follow-up of 4.8 years. CONCLUSIONS: For adults who have symptoms and activity limitations related to uncorrected pectus chest deformities, surgical repair can be performed with low morbidity, low cost, minimal limitation in activity, and a high frequency of symptomatic improvement. The operation in adults is more difficult than in children, although the results are similar.

Adult↗
PubMed2006

Acquired deformities of the anterior chest wall.

BACKGROUND: Acquired chest wall deformities are difficult to describe and to classify. We propose the following classification and treatment options. METHODS: We observed 11 patients with acquired deformities (AD) that required surgical correction. RESULTS: AD of the chest can be classified into 4 groups: (1) AD resulting from a pathological process within the thorax (heart enlargement, mediastinal tumors), (2) AD resulting from chest wall disease (rib osteomyelitis or tumors), (3) iatrogenic deformities (following rib graft harvesting, acquired Jeune's syndrome), and (4) post-traumatic deformities. Group 1 requires treatment of the pathological process. Group 2 is guided by oncological or infectious disease principles. Groups 3 and 4 require chest wall reconstruction. Iatrogenic AD usually occur after pectus excavatum repair with rib cartilage extirpation in young patients, which results in a reduced, restricted thorax. Post-traumatic AD often have pathological chest wall mobility owing to pseudo-articulation of injured ribs. CONCLUSIONS: To prevent AD formation and to protect thoracic growth and mobility, costosternal and costochondral junctions should be preserved during cartilage resection. Substernal suturing of the perichondrium should be avoided.

Cartilage↗
PubMed1990

[Radical surgical techniques for pectus excavatum].

Conservative techniques with insertion of a subcutaneous implant have the advantage of being simple to perform but the frequent disadvantage of a poor result. The authors present two more radical techniques used in chest surgery: modelling osteochondroplasty and resection of the deformed sternocostal plate and replacement by a prosthesis. The indications are described together with the very satisfactory results with no major complications obtained in a series of 13 cases.

Adolescent↗
PubMed1996

Chest wall deformity following maximal tissue expansion for breast reconstruction.

Forty-three women, in a series of 150, participated in a prospective study that examined their chest walls for deformities 3 months after maximal tissue expansion for single-breast reconstruction. Computed tomography imaging was used for this purpose. Twenty-one patients underwent immediate breast reconstruction and the other 22 patients underwent delayed reconstruction. Fifty-three percent had some chest wall abnormality. In the delayed group, chest wall deformities were more statistically significant (p < 0.001). Our findings suggest that chest wall deformity is a common occurrence after maximal tissue expansion for breast reconstruction.

Adult↗
PubMed2004

Severe hypotension in the prone position in a child with neurofibromatosis, scoliosis and pectus excavatum presenting for posterior spinal fusion.

UNLABELLED: A 34-mo-old boy with neurofibromatosis, scoliosis, and pectus excavatum developed severe hypotension when positioned prone. A magnetic resonance image study revealed neurofibromas encircling the great vessels. During the next anesthetic the patient was placed in the prone position on transverse bolsters and hypotension ensued again. A transesophageal echocardiogram (TEE) revealed compression of the right ventricle by the sternum. When the child was turned supine, the blood pressure returned to baseline. The patient was returned to the prone position, this time with bolsters placed longitudinally, without problem. This case supports a cardiac evaluation, possible intraoperative TEE, and avoidance of sternal pressure in patients with chest wall deformities requiring prone positioning. IMPLICATIONS: A child with neurofibromatosis, scoliosis, and a chest wall deformity presenting for spinal fusion developed severe hypotension while prone. This was due to compression of the heart by the sternum, not compression of the great vessels by neurofibromas. Sternal pressure in prone patients with chest wall deformities should be avoided. Unique management included the use of transesophageal echocardiography to determine the cause of the hypotension.

Adult↗
PubMed1979

Pectus excavatum deformities simulating mediastinal masses.

Three patients with various pectus excavatum deformities in whom radiographic findings suggested hilar and mediastinal masses are presented. Computed tomography of the chest yielded valuable diagnostic information and made it possible to exclude the existence of these masses. Compression deformity of the heart and great vessels by the pectus deformity is the most likely explanation for these findings.

Adult↗
PubMed2002

[Scoliosis and congenital diaphragmatic agenesis].

PURPOSE OF THE STUDY: Diaphragmatic agenesis is the most extreme anatomic form of congenital diaphragmatic defects. Clinically this pathology is not different from posterolateral diaphragmatic hernia described by Bochdalek. We describe our observations of scoliosis in 16 neonates with diaphragmatic agenesis. MATERIAL AND METHODS: Between 1987 and 1996, 69 neonates underwent surgery for a congenital diaphragmatic hernia (CDH) at our institution. Sixteen of these patients had the most extreme form of CDH. Ten of these 16 patients survived. Spinal and/or chest wall deformities were observed in nine patients, including isolated scoliosis in two patients, scoliosis associated with a chest wall deformity in three, and isolated chest wall deformity (pectus excavatum or pectus carnium) in four. These deformities developed between 13 months and three and a half years of age (mean: two years). RESULTS: For two patients the deformity was mild (Cobb angle<15 degrees ) and required only observation. A Milwaukee brace was used in three patients that had severe kyphoscoliosis. Isolated chest wall deformities were treated with observation. No patient required operative treatment for these skeletal deformities. DISCUSSION: The preliminary results of this study indicate that chest wall deformities and scoliosis frequently occur during surgery for diaphragmatic agenesis. Nonoperative treatment is usually sufficient, however, follow-up of these patients until adulthood is recommended.

Abnormalities, Multiple↗
PubMed1977

Suprasternal notch echocardiography. Assessment of its clinical utility in pediatric cardiology.

Echocardiographic suprasternal relationships of the transverse aortic arch (TAA), right pulmonary artery (RPA) and left atrium (Y' LAD) were validated and angiographic-echocardiographic measurement correlations were made for each structure. Normal values were determined with respect to body surface area. In normals, regardless of age or body size, mean dimensional TAA/RPA ratio was 1.2:1 and Y' LAD equaled the anterior-posterior, or Z axis, left atrial dimension (Z LAD)- TAA/RPA ratio was increased in aortic stenosis and tetralogy of Fallot and was decreased in ventricular septal defect, atrial septal defect and pulmonary stenosis. Ratio did not correlate with lesions severity as assessed by cardiac catheterization except in pulmonary stenosis. Discrepant Y' LAD values (usually increased Y' LAD and decreased Z LAD) occurred in children with various forms of heart disease. Some had sternal compression but others had normal chests. Children with pectus excavatum showed similar compression. These findings underscore the need for incorporation of a suprasternal examination into the standard echocardiographic examination of children.

Adolescent↗
PubMedDate not supplied

Congenital chest deformities.

The authors discuss 334 patients operated upon for congenital deformities of the chest. The clinical manifestations, radiological and electrocardiographic investigations and spirometric measurements as well as postoperative complications are described. The results of follow-up examinations in a part of this material are reported.

Adolescent↗
PubMed1995

Correction of pectus excavatum combined with open heart surgery in a patient with Marfan's syndrome.

We report a patient with Marfan's syndrome and pectus excavatum who underwent open heart surgery with simultaneous correction of the sternal malformation. Permanent internal stabilization, achieved by bilateral overlapping of the bevelled ends of the lowest ribs and reinforced with sternal closure wires offered a maintained postoperative chest wall stability, avoided the potential postoperative complications of cardiac compression, and improved the aesthetic appearance of the anterior chest wall. The increased risk of bleeding due to extensive dissection was minimized by postponing the repair of pectus excavatum to when protamin is administered after termination of cardiopulmonary bypass.

Aortic Aneurysm↗
PubMed1984

Silicone implant correction of pectus excavatum: indications and refinement in technique.

Pectus excavatum is the most common deformity of the chest wall. The overwhelming majority of patients with pectus excavatum have no physiologic compromise. Adolescents beyond their growth spurt and adults who are asymptomatic are best served by placement of a silicone implant to correct the chest-wall defect. We have treated 12 patients in this manner. The initial 7 were treated with placement of a subcutaneous implant. Despite patient satisfaction, we noted several problems that compromised the aesthetic result. In the last 5 patients, the implant has been placed subpectorally, and room temperature vulcanizing silicone has been used to augment the preformed silicone implant if necessary. Subpectoral placement of a preformed silicone implant is a relatively minor procedure with a short hospital stay and minimum morbidity. It avoids a major reconstruction of the chest wall with its inherent risks and complications and provides a pleasing aesthetic result. All 5 patients, 4 of whom had severe deformity, have had good results with postoperative follow-ups of between 8 months and 2 years.

Adolescent↗
PubMed1987

[Pathogenesis of chest wall abnormalities--electron microscopy studies and trace element analysis of rib cartilage].

In 71 patients with chest deformity (Group B) and in 43 patients who underwent thoracotomy due to heart disease (Group BN), cartilage of the ribs was removed intraoperatively. Analyses of trace elements showed a highly significant decrease in zinc, coupled with a significant increase in magnesium and calcium in Group B. Electron microscope studies in the cartilage of patients with chest deformity revealed chondrocytes with a normal structure only in some parts, but many degenerative altered chondrocytes with vacuoles of fat and osmiophilic depositions, as well as atypical fibrils and so-called "long-spacing collagen".

Adolescent↗
PubMed2006

Current concepts in surgical management of pediatric lung and chest wall diseases.

PURPOSE OF REVIEW: The management of pediatric lung and chest wall diseases has changed dramatically in the last decade because of the application of minimally invasive surgical techniques. This review will try to highlight some of the more significant recent contributions. RECENT FINDINGS: Most of the papers quoted will show that the application of minimally invasive surgery to the treatment of common problems such as empyema, pneumothorax, and lung biopsy has significantly altered our treatment algorithms, because of decreased morbidity and improved outcomes compared to standard surgical or medical treatment plans. This has also been true for pediatric chest wall deformities, which previously were treated in only the most severe cases and thought to be mostly cosmetic in nature. More recent reports now show statistically significant improvements in cardio-pulmonary physiology as well as quality of life. SUMMARY: The application of less invasive surgical procedures for lung and chest wall diseases has warranted earlier intervention, with better outcomes, and less morbidity than previously used techniques. A clear understanding of these techniques and their benefits is important for the referring and treating physician as previously used treatment protocols may no longer provide the best patient care.

Biopsy↗