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PubMed1992

Pectus excavatum.

Pectus excavatum is a congenital chest wall defect that can cause a marked cosmetic defect with attendant psychologic trauma and limitations of peak physical performance. Close observation of pectus excavatum is indicated, because this condition may improve or even disappear without treatment in some patients. However, in appropriate patients, timely surgical repair can give good cosmetic results and improve cardiorespiratory function, providing both physical and psychologic benefits.

Adolescent↗
PubMed2002

Pulmonary problems and management concerns in youth sports.

In the overwhelming majority of exercising youngsters, exercise tolerance is limited by cardiovascular and muscular factors, not the lungs. Even at exhaustion, pulmonary reserve is considerable. Yet some young athletes do experience respiratory problems with exercise. These problems can be assigned to several categories, including those related to underlying acute and chronic respiratory conditions (principally respiratory tract infections, asthma, cystic fibrosis, chest wall deformities, and neuromuscular disorders), and apparent but nonpathological problems (the heavy breathing of anaerobic exercise, relative deconditioning, and anxiety). There are also situations that seem to be problematic but need not be (having the diagnosis of asthma or cystic fibrosis). Pharmacologic management of respiratory problems and perceived problems can be difficult and is discussed with the particular disorder.

Adolescent↗
PubMed2000

Cardiopulmonary effects of anterior chest wall deformities.

Many studies have been conducted that evaluate the cardiopulmonary effects of pectus excavatum because of the general clinical impression that post-repair patients have better exercise tolerance and vigor. The results of these studies have been variable during the last three decades, and although restrictive lung volumes are often present in subjects with pectus excavatum, they are not invariably improved by repair. Enhanced cardiac performance may be partially responsible for improved function. This article reviews the results of these studies.

Cardiac Catheterization↗
PubMed1995

Radiographic findings after pectus excavatum repair.

Postoperative radiographic changes after pectus repair have not previously been described. We reviewed the chest radiographs of 65 children who underwent surgical repair of pectus excavatum between early 1985 and mid-1992. After operation, 64 children showed atelectasis, 38 had pleural effusions, 30 showed a congestion or edema pattern, 12 had pneumothorax, 21 showed fixation strut tilt or rotation, and 4 had pneumomediastinum. Despite the sometimes worrying radiographic appearance, these children uniformly did well clinically.

Adolescent↗
PubMed1987

Use of CT scans in selection of patients for pectus excavatum surgery: a preliminary report.

A pectus index can be derived from dividing the transverse diameter of the chest by the anterior-posterior diameter on a simple CT scan. In a preliminary report, all patients who required operative correction for pectus excavatum had a pectus index greater than 3.25 while matched normal controls were all less than 3.25. A simple CT scan may be a useful adjunct in objective evaluation of children and teenagers for surgery of pectus excavatum.

Adolescent↗
PubMed1977

[Cardiocirculatory complications and ECG changes in patients operated on for severe deformations of the anterior chest wall].

After a brief literature review on the indidence of these diseases, the authors present a comprehensive analysis of a group of 117 patients, operated and treated by them, for the period from 1968 t0 1975 includ. They discuss in details the cardiocirculatory complications and ECG changes in those patients undergone operations for severe deformities of the anterior chest wall. Their observations and results obtained are well illustrated in three tables. Furthermore, they try to explain why those electrocardiographic changes do no disappear after the carried out operation treatment. Finally, they propose the inclusion of a new stage in the operation treatment of these patients, being a significant contribution to the operation treatment and the definite elimination of ECG changes.

Adolescent↗
PubMedDate not supplied

Pectus excavatum. More than meets the eye.

Pectus excavatum is an anterior chest deformity that is characterized by a depressed sternum. Physical examination is the primary means of diagnosis. Common surgical operations to correct this malformation include the Ravitch and Nuss procedures, both of which have favorable postoperative outcomes. This deformity affects physical, emotional and psychological well-being. In addition, there are several important nursing interventions that need to be considered when caring for patients who have undergone surgical repair for pectus excavatum.

Body Image↗
PubMed1987

[Autologous transfusion of blood deep frozen in the interim in childhood].

In the report we describe a method of reducing the number of transfusions of heterologous blood in patients with a surgical correction of chest walls. In 71 children between 2 and 17 years of age, 10-15% of total blood volume were withdrawn 3-4 weeks before the operation, deep frozen and thawed at the appropriate time to be ready for retransfusion. This arrangement reduced the need of heterologous blood significantly from 18.6% (prior to the introduction of the method) to 4.2%.

Adolescent↗
PubMed2003

Pectus deformities of the anterior chest wall.

Pectus deformities affect about 1% of the population. Despite a subjective reduction in exercise tolerance, objective physiological disturbance is very uncommon. However, there is no doubt that cultural changes have significantly altered perception and tolerance of these deformities and increasing numbers of children are actively seeking surgery. Pectus excavatum is readily amenable to correction using minimally invasive techniques and pectus carinatum can be corrected using safe established conventional techniques. Good or excellent results can be expected in over 90% of cases, and children should no longer be denied treatment.

Funnel Chest↗
PubMed1994

[Malformations of the anterior thoracic wall].

The different anomalies of the anterior Chest Wall are exposed. We emphasize the deformities of the sternum--Depression and Protusion Deformities--because they are the most common and the most difficult ones to treat. Based in the results of 73 patients operated upon by the author, and in the review of the bibliography, we also comment on some aspects of the surgical indication, assessment methods, surgical technique, complications and results.

Child↗
PubMed2000

Repair of pectus excavatum. Anesthetic considerations.

The majority of patients undergoing pectus excavatum repair can be safely anesthetized with routine clinical preoperative evaluation and chest radiography. Electrocardiography, echocardiography, arterial blood gas, and pulmonary function tests should be reserved for patients with suspected coexisting conditions, such as mitral valve prolapse, skeletal abnormalities, Marfan's syndrome, and pulmonary disease. The choice of surgical repair and the advisability of placement of an epidural catheter or intercostal blocks for perioperative pain management should be discussed with the surgical team. Postoperatively, patients should be carefully monitored for signs of tension pneumothorax and pneumonia.

Anesthesia↗
PubMedDate not supplied

Scoliosis in children with pectus excavatum and pectus carinatum.

Between 1974 and 1985, 461 patients with pectus excavatum and 135 patients with pectus carinatum underwent operative repair of their anterior chest wall deformities. Twenty-one percent of patients with anterior chest wall deformity had mild scoliosis by clinical and radiographic examination. The average lateral spinal deformity was 15 degrees (range 6-78 degrees) for pectus excavatum patients and 16 degrees (range 5-57 degrees) for pectus carinatum patients. Eighteen percent of the pectus excavatum patients with scoliosis and 14% of the pectus carinatum patients with scoliosis required therapeutic intervention of bracing and/or arthrodesis.

Adolescent↗
PubMed2005

A 3-year experience of a minimally invasive technique for correction of pectus excavatum in Croatia.

The aim of this study was to assess the early results of a three-year experience with the minimally invasive correction of pectum excavatum, which requires no cartilage incision or excision, and no sternal osteotomy. Since 2001 we have performed 35 minimally invasive pectus excavatum procedures at our hospital. A convex steel bar is inserted under the sternum through small bilateral incisions, and removed after 2 years when permanent remolding had occured, the bar is removed. Complications were pneumothorax in 5 patients (only 1 required a thoracostomy tube, the other 4 resolved spontaneously), pneumonia in 3 patients, and bar displacement in 1 patient. The mean follow-up was 3 months to 3 years. Initial excellent results were maintained in 28 patients (normal postoperative chest), good results in 5patients (mild residual pectus) and poor in 2 patients (severe recurrence requiring further treatment). Poor results occurred because the steel bar was too soft in 1 patient, and the sternum too soft in 1 patient with Marfan's syndrome. Our early results with the minimally invesive technique without cartilage incision and resection or sternal osteotomy showed that the procedure is effective with excellent preliminary results.

Adolescent↗
PubMed2004

Management of pectus chest deformities in female patients.

BACKGROUND: There is sparse published information regarding surgical management of females with pectus excavatum (PE) or carinatum (PC) deformities. METHODS: During the past 33 years 104 females with PE, and 21 with PC underwent surgical repair using extensive modifications of the Ravitch technique. Seven had previous right breast implants, 3 had prostheses placed in the PE deformity. Nine PE patients underwent successful pregnancy before repair, but had severe third trimester dyspnea. RESULTS: Very good to excellent results were reported by 96% (mean follow-up, 6 years). Increased endurance, decreased dyspnea, reduced chest discomfort, and less tachycardia occurred in all within 6 months. No patients had significant breast asymmetry after repair. Complications included mildly hypertrophic scar (8), transient pleural effusion (3), bar displacement (1), and mild recurrence (3). CONCLUSIONS: Females with symptomatic PE or PC, can be repaired with low morbidity, mild pain, low cost, and improvement in body image and symptoms. Prostheses are not beneficial in the treatment of physiologic symptoms caused by pectus deformities.

Adolescent↗
PubMed2005

Cardiopulmonary resuscitation in patients with a Nuss bar--a case report and review of the literature.

Pectus excavatum (PE) is a common chest wall deformity that may produce a variety of physiological and psychological effects in children and adolescents. In addition, some of these patients have associated cardiac diseases (ie, mitral valve prolapse and Marfan syndrome). Recently, a minimally invasive surgical repair of PE that requires sternal bar placement has become increasingly frequent to enhance patients' cardiopulmonary functioning as well as their self-esteem. However, despite this innovative technique, it is possible for such patients to have a cardiac arrest while their sternal bar is in place. Whether the presence of a metal bar on the underside of their sternum may hinder resuscitative chest compressions (cardiopulmonary resuscitation) is an issue that concerns us, our patients, and their families; the answer requires further investigation. We present a 21-year-old man with PE who underwent a minimally invasive pectus repair but had a fatal cardiac event before bar removal. Paramedics conducting cardiopulmonary resuscitation on the patient later reported that they were unable to deliver effective cardiac compressions and that the sternal bar may have contributed to this.

Adult↗
PubMed1975

[Surgical correction of the pectus excavatum and carinatum in the adult. Report of an unusual case of combination of the straight back and pectus excavatum].

Surgical correction of pectus excavatum et carinatum in a series of adult patients is described. The relationship between deformity of the anterior chest wall and cardiac, respiratory and digestive disturbances is assessed. The indications for surgical management are explained. Reference is also made to the satisfactory morphological and respiratory function results observed on follow-up. An unusual cases of pectus excavatum associated with straight back is separately described. Here again, successful surgical management was achieved, coupled with disappearance of functional disturbances and improvement of the heart picture.

Adolescent↗
PubMed1992

Pulmonary scintigraphic findings in children with pectus excavatum by the comparison of chest radiograph indices.

Pulmonary scintigraphy, including Xe-133 ventilation combined with Tc-99m MAA perfusion scans, was performed in 23 children (3 girls, 20 boys, ages: 2-9 years) with pectus excavatum, and the indices from lateral chest radiography were used for comparison. The findings of pulmonary scintigraphy were analyzed as 1) ventilation fractions (VF), and 2) perfusion fractions (PF) between bilateral lungs; and 3) ventilation-perfusion ratios (V/Q ratio) of both lungs. The results showed that 6 of 23 cases had impaired VF, 11 of 23 cases had impaired PF, and 7 of 23 cases had an impaired V/Q ratio in the right and left lung, respectively. The severity of sternal depression in pectus excavatum was shown as certain indices that were obtained on routine lateral chest radiographs. However, no significant correlations existed between the differences in the fractions and the indices. Our results suggest that pulmonary scintigraphy is not necessary for children with pectus excavatum to predict the severity of sternal depression and pulmonary function, because 1) pulmonary scintigraphy is very difficult to perform in children; 2) unnecessary radiation exposure should be avoided; and 3) it is not well correlated with the severity of the depressed sternum.

Child↗
PubMed2000

Repair of pectus excavatum deformities: 30 years of experience with 375 patients.

OBJECTIVE: To review the surgical experience with pectus excavatum chest deformities at UCLA Medical Center during a 30-year period. BACKGROUND: Pectus excavatum is a relatively common malformation that is often symptomatic; however, children's physicians often do not refer patients for surgical correction. METHODS: Hospital records from 375 patients who underwent repair of pectus excavatum deformities between 1969 and 1999 were reviewed. Decrease in stamina and endurance during exercise was reported by 67%; 32% had frequent respiratory infections, 8% had chest pain, and 7% had asthma. The mean pectus severity score (width of chest divided by distance between posterior surface of sternum and anterior surface of spine) was 4.65 (normal chest = 2.56). All patients had marked cardiac deviation into the left chest. Repair was performed with subperiosteal resection of the abnormal cartilages, transverse wedge osteotomy of the anterior sternum, and internal support with a steel strut for 6 months. Repair was performed on 177 children before age 11 years; 38 adults with severe symptoms underwent repair. RESULTS: The mean hospital stay was 3.1 days. With a mean follow-up of 12.6 years, all patients with preoperative respiratory symptoms, exercise limitation, and chest pain experienced improvement. Vital capacity increased 11% (mean) within 9 months in 35 patients evaluated. There were no deaths. Complications included hypertrophic scar formation (35), atelectasis (12), pleural effusion (13), recurrent sternal depression (5), and pericarditis (3). More than 97% had a very good or excellent result. CONCLUSION: Pectus excavatum deformities can be repaired with a low rate of complications, a short hospital stay, and excellent long-term physiologic and cosmetic results.

Adolescent↗