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PubMed1975

Thoracic skeletal abnormalities in idiopathic mitral valve prolapse.

Idiopathic prolapse of the mitral valve is a common disorder, but many cases are clinically subtle. Thoracic skeletal abnormalities, reported recently to accompany the syndrome, may serve as an easily identifiable clinical indicator. The prevalence of these abnormalities was defined in 24 patients with proved prolapse of the mitral valve. The valvular syndrome was defined clinically, by echocardiography and, in seven cases, by left ventricular angiography. The skeletal deformities were defined clinically and radiographically. Pectus excavatum was present in 62 percent of the patients, "straight back" in 17 percent and severe scoliosis in 8 percent. Eighteen of the 24 patients (75 percent) had a definite thoracic skeletal deformity. The association of idiopathic prolapse of the mitral valve with these skeletal deformities may represent a forme fruste of Marfan's syndrome. Patients with "straight back" and pectus excavatum should be examined clinically and perhaps by echocardiography to exclude idiopathic prolapse of the mitral valve; when murmurs are present, a diagnosis of "pseudoheart disease" should not be made before mitral valve prolapse has been excluded.

Adolescent↗
PubMed1994

Staged approach to combined repair of pectus excavatum and lesions of the heart.

The combined repair of severe pectus excavatum and cardiac lesions remains technically difficult. We report our experience with a patient undergoing such a combined repair of pectus and implantation of an aortic valved conduit in the setting of the Marfan syndrome. The procedure was staged such that the dissection and bony mobilization was done at the first procedure before heparin administration in combination with a sternal split and subsequent aortic repair. The second stage of sternal repositioning and cartilage resection was completed several days later with excellent cardiopulmonary and cosmetic results. The technique and a review of the literature are included.

Adult↗
PubMed1994

Oblique wedge osteotomy for correction of asymmetric pectus excavatum in young children.

The procedure modified by Ravitch is usually used to correct pectus excavatum. Young children with asymmetric sternal depression need more modification of the procedure to maintain the sternum in the elevated flat position. In this report we describe a modification of the sternal elevation procedure, including an oblique wedge osteotomy through the anterior table, to correct the asymmetric sternal depression in young children.

Child↗
PubMed1996

Left thoracotomy for coronary bypass in a patient with pectus excavatum.

In a patient with pectus excavatum, coronary artery bypass grafting with the internal mammary artery is difficult or even impossible through a median sternotomy. We suggest and describe an anterolateral thoracotomy that, in this particular case, not only allowed taking the internal mammary artery but also provided an excellent exposure of the anterolateral aspect of the heart.

Coronary Artery Bypass↗
PubMed1995

Cardiac perforation after surgical repair of pectus excavatum.

Five days after surgical repair of pectus excavatum, this 7-year-old boy had a right-sided Kirschner wire protruding beneath the skin. The wire was repositioned blindly. Severe congestive heart failure developed. Surgical exploration showed a pierced right atrium, a torn septal leaflet of the tricuspid valve and noncoronary aortic cusp, and a large traumatic ventricular septal defect. The outcome and the indications and possible complications of surgery are discussed.

Bone Wires↗
PubMed1990

Implantation of porous acrylic cement in soft tissues: an animal and human biopsy histological study.

Long-term (8 and 24 month) reactions of the (hypo) dermis of the guinea pig to solid and porous (50 vol%) acrylic implants and four human biopsies from porous subcutaneous acrylic implants were studied light microscopically. The solid implants were encapsulated by dense connective tissue. Mobility was evidenced by the loss of 4 out of 36 after 2 yr and was considered the explanation for the occurrence of ectopic cartilage and mineralized material at some solid implants' surfaces after 2 yr. A dense capsule was not evident with the porous implants, instead vascularized collagenous connective tissues penetrated into and filled the pores, thus anchoring the implant to the body. None of these implants, was lost. Notwithstanding the presence of some multinucleated giant cells, scattered inflammatory cells and loosely packed inflammatory foci with both implant materials, the materials were considered well-tolerated by the body. The histology of the human biopsy did not differ significantly from the porous animal implants.

Acrylic Resins↗
PubMed1990

Abnormalities of the bony thorax causing tracheobronchial compression.

A number of intrathoracic and extrathoracic causes of airway obstruction have been well documented in the literature. At times, tracheal compression may be caused by abnormalities of the bony thorax whose previously unrecognized significance can result in unexpected difficulties when extubation is attempted following a routine intubation. Alternatively, patients may develop progressive distress secondary to their skeletal abnormalities. We report on cases illustrating anomalies of the manubrium, sternum and spine which have caused significant, occasionally life-threatening, tracheal and bronchial narrowing including pectus excavatum and scoliosis. A protocol is presented detailing the appropriate methods of diagnosis and treatment of these types of deformities.

Adolescent↗
PubMed1996

A new technique of reinforced sternal closure.

A technique of reinforced sternal closure with stainless steel Kirschner wires is described. This technique is useful for patients with a fractured or friable sternum, or pectus excavatum.

Bone Wires↗