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[Correction of funnel chest using the Senning-Johanson method].

Between 1962 and 1987 52 patients underwent surgical reconstruction of pectus excavatum at the University Hospital of Zurich using the Senning-Johanson method, first published in 1974. The technique of Senning-Johanson consists of a Y-shaped sternotomy and a transsection of the involved ribs from inside of the thoracic cage, thereby avoiding a dissection of the anterior chest wall. The average age of the 36 men and 16 women was 20 years (range 12-33). The internal sterno-vertebral distance, which we consider to be a good parameter for determining the anatomic dimension of a funnel-chest, was extended by the operation from an average of 5.8 cm (range 2.5 to 10) to 10.1 cm (range 6.1 to 14) or 74% of the original value. The physical working capacity in sitting position was improved by 10%. The vital capacity was preoperatively normal and was not changed by the operation. Thirty-seven patients considered the operative result to be good, in twelve it was satisfactory, and in three bad. The funnel-chest repair using the Senning-Johanson method can be recommended as a successful procedure with relatively few complications for the adult patient.

Adolescent↗

[Funnel chest and pigeon chest today].

The authors report on the results of sternochondroplasty according to Ravitch in a group of 31 patients with funnellike or carinated chest. The results appear to be conditioned to the type of anomaly, to the kind of surgery performed, to the age at which the patients undergo surgery. From a functional viewpoint results appear to be markedly better in pectus carinatum as compared to those in pectus excavatum. The latter anomaly requires a prolonged traction of the anterior thoracic "volet": this excludes any possibility of using external traction techniques (poor results in 25-30% of cases). The high percentage of fair results with reference to marring scars or partial excavations of the thoracic wall has lead us to operate (with reference to some ages: less than 5 years old; 9-14 years old) on these patients after they have reached age 15. The authors hope that a larger number of patients will be treated conservatively (in cases of carinated chest) or else that they undergo minor plastic surgery (in funnel chest cases).

Adolescent↗

[A 13-year-old male with a funnel chest treated by sternal elevation].

A 13-year-old male with a funnel chest was treated by sternal elevation method. Reconstruction was performed by resection of rib cartilage, wedge osteotomy of the anterior site of the sternum, sternal elevation by placement of a titanium A-0 plate under the sternum, and fixation of the wedge osteotomy site by a titanium plate. After surgery, the chest wall deformity was improved remarkably without complication. Although the A-0 plate was removed 19 months after surgery due to a break in the plate, cosmetic and functional results are now excellent 28 months after surgery.

Adolescent↗

[FUNNEL CHEST].

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Diagnosis↗

[Echocardiographic evaluation of funnel chest after surgical intervention].

An analysis of echocardiographic examination in 22 patients operated for funnel chest is presented. Patients were divided into two groups: group I--isolated anomaly, and group II--patients with coexistent other postural deformations. During the operation, rib's cartilages in the parasternal region were excised, sternum was cut transversally above the deformation and longitudinally across it, and than anterior thoracic wall was stabilized in the proper position with Kirschner's wires. Before and 6 months after surgery echocardiographic examinations were performed with systolic, diastolic and ejection volume indices calculation. marked haemodynamic improvement was noted with the increase of diastolic and ejection volume of both heart ventricles. Improvement was more evident in patients with severe deformations and with coexistent other postural anomalies.

Adolescent↗

[Scoring system for indication for operative correction of funnel chest (author's transl)].

Based on 50 consecutive patients whom we operated for funnel chest, we tried to work out the indications for operative correction by developing a scoring system. In this scoring system we considered not only the depth of of the funnel respectively the depth of the impression, but also all the other disturbances of the organs of the chest resulting from the malformation. The possible accompanying deformities of the thoracic cage were taken into account too. The scoring system demands a more stringent indication.

Adolescent↗

[Pathohistology of costal cartilage and immunomorphologic characteristics of collagen in funnel chest].

Biopsy samples from the costal cartilage tissue were studied for 68 children with funnel deformity and from 20 children with normally formed chest. The authors present general morphologic features characteristic of the costal cartilage structure in norm and in case of funnel chest. These features include vast acellular sites, map-like areas, unmasked chondrin fibers and "marrow" cavities. In funnel chest they develop, however, 6-7 years earlier, than normally, and are consequent stages of the accelerated costal cartilage involution. Costal cartilage matrix was found to have an increased content of fibronectin and V collagen type in case of funnel chest. Besides III and IV procollagen types were noted in the chondrocytes. The accelerated growth of costal cartilages is involved in the formation of funnel chest.

Adolescent↗

A vascularised rib strut technique for funnel chest correction.

We have refined the Ravitch technique of sternal elevation for surgical correction of funnel chest. Our major modification is introducing a living rib strut for supporting the elevated sternum. The left 5th rib with a vascular pedicle from the internal thoracic artery is turned 180 degrees beneath the sternum. We have used this method in 10 cases. The results have all been satisfactory.

Adolescent↗

[One-stage correction of heart defect and funnel chest in the Marfan syndrome].

The first experience of simultaneous operations for heart defect and funnel chest in adult patients with the Marfan syndrome is presented. One-stage correction permits simultaneous removal the underling (valvular disease) and concomitant (laterocaudal ectopia of the heart and central vessels due to deformity of the anterior thoracic wall) causes of hemodynamic disorders. It is concluded that this policy is expedient in strictly selecting patients.

Adolescent↗

[Funnel chest].

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Funnel Chest↗

[Funnel chest].

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Funnel Chest↗

[Funnel chest].

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Funnel Chest↗