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[Platy-thorax as a constitutional anomaly, with special reference to funnel chest].
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A simple sternal turnover procedure using a vascular pedicle for a funnel chest.
We have improved the sternal turnover surgical procedure by using a vascular pedicle for a funnel chest. Rather than performing a simple sternal turnover, we thought it better to use the sternum with the vascular pedicle attached, anticipating that this would lead to fewer postoperative complications and a more desirable result. The following method for performing the operation was devised: (1) cutting the deformed sternum at the second intercostal position; (2) cutting the second costal cartilages to allow a repositioning of the vascular pedicle onto the presternal surface; (3) turning the sternum over, placing one end on the other, and attaching one end to the other; and (4) making a groove in the turned-over sternum to prevent the decussated vascular pedicle from becoming constricted. By using this method, it is easily possible to keep the bilateral internal thoracic vessels intact. We used this surgical technique on a 17-year-old boy and obtained very favorable results.
[Surgical correction of early forms of funnel chest in children with Marfan's and Ehlers-Danlos syndromes].
A prophylactic trend was developed in surgical treatment of funnel chest on basis of a syndromal approach to solution of applied problems of clinical medicine. Patients with an established diagnosis of progressive funnel deformity underwent early prophylactic sparing one-stage thoracoplasty according to the authors' own method, which made it possible to prevent progress of the deformity in the early stage; such treatment had a positive effect on further physical and mental development of the child. Besides, the method of operation had a lesser injurious effect and reduced the number of complications; it also considerably reduced the expenditures and shortened the period of treatment.
[Late results of the surgical correction of funnel chest. Evaluation with subjective and objective criteria including moiré topography].
The long term results of 32 patients with funnel chest deformity that were operatively treated by means of Rehbein's metal implants have been reviewed. The investigated criteria were electrocardiography, pulmonary function, radiographical measurements, and photogrammetry of the frontal thoracic plane (Moiré-Topography). There was no significant change of the electrocardiography and pulmonary function due to the operative treatment. Roentgenometric and surface measurement data showed in 40% of the cases investigated minor up to complete relapses. According to the results the indications for operative treatment and the importance of the patient's age at this time are discussed.
[Pulmonary sequestration associated with localized cystic bronchiectasis and funnel chest].
A 37-year-old woman, who presented with low grade fever and productive cough, was admitted for evaluation of an abnormal shadow on chest X-ray film. On physical examination, she had bilateral hallux valgus and funnel chest, the center of which was at the fifth rib on the right edge of the sternum. Since chest CT scan, selective bronchography, pulmonary arteriography and aortography revealed that she had pulmonary sequestration in the right cardiophrenic region associated with localized cystic bronchiectasis in the right S7b, she received right lower lobectomy. Histological examination showed the cystic change of bronchioli and a small number of emphysematous alveoli in the right S7b adjacent to the sequestered lung. The bronchopulmonary structure of right S7a was almost intact. It might be speculated that the existence of the sequestered lung constituted to the deterioration of the development of the lung and the rib cage adjacent to it.
[Funnel chest: filling technique with deep custom made implant].
Through 97 patients over 9 years, the authors present a surgical treatment for "funnel chest" using custom-made silicone elastomer prothesis which are deeply placed, behind muscle and aponevroses. They justify the choice of this simple and non invasive technique, by the fact that this deformation is only morphological in most cases or even only inaesthetic with exceptional cardiac or pulmonary consequences. Patient's motivation being mainly due to psychological disconfort, the non invasive aspect of the technique leads them to choose surgery, particularly as results are good and complications seldom.
[THE INDICATION FOR SURGICAL TREATMENT OF FUNNEL CHEST].
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A repair of funnel chest without sternal dissection in aortic root replacement.
A 46-year-old man with Marfan syndrome was admitted for repair of annuloaortic etasia and funnel chest. Before median sternotomy, seven transverse skin incisions were made for resection of deformed ribs. The convex portions at the costochondral junctions of the right 4 approximately 7th and left 5 approximately 7th ribs were removed. Thereafter, the conventional median sternotomy was safely performed. Aortic root was replaced. After weaning from the cardiopulmonary bypass, the redundant distal end of the sternum was resected, fractured sites of the concave sternum were straightened and secured with wire fixation, and the split sternum was sutured with wires in an ordinary fashion.
[Congenital funnel chest in children].
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[Results of operative correction of pigeon and funnel chest following a modified procedure of Ravitch and Haller (author's transl)].
A surgical technique which is a modification of the technique described by Ravitch is presented in detail. We employed it in 441 patients, among them 85% with funnel chest, 11% with pigeon breast and 4% with combined funnel-pigeon breast. The pre- and postoperative measurement of the chest deformity which provides an objective evaluation of the surgical result is described. The postoperative results were in 91% satisfactory and in only 9% unsatisfactory. No postoperative death was observed in the last 420 patients. The overall mortality in the world literature is 0,05%.
[Life-threatening complication of the Nuss-procedure for funnel chest. A case report].
This report is the first description of an additional major complication seen with the Nuss repair. In addition to the conventional Rehbein and Ravitch operations for funnel chest, the minimally invasive procedure developed by Nuss has recently been added to the therapeutic options. The present report describes the case of a 21-year-old man who underwent a Nuss repair with implantation of 2 pectus bars 4 months previously. During the primary operation the central tendon of the left diaphragm was unnoticed injured. We performed an emergency operation on the patient to repair an incarcerated diaphragmatic hernia. The thorax was found to contain not only the entire, twisted stomach, but also the transverse colon and the spleen. During induction of anaesthesia the patient suffered a cardiovascular collapse. After successful resuscitation, thoraco-abdominal surgery was performed and the diaphragm closed from the thoracic side. Other authors have also reported major life-threatening complications of the Nuss-procedure, such as perforation of the heart. A careful evaluation of this procedure and the establishment of clear indications taking the age of the patient, the thoracic deformity and connective tissue disease into account, are mandatory to avoid discredit of this method.
Characterization of costal cartilage collagen in funnel chest.
Parallel measurements of pyridinoline content, the ratio of soluble:insoluble collagen, and the percentage of endogenous collagenolysis were made in samples of costal cartilage from forty-five children with funnel chest (FC) and from twenty-two control children. From an analysis of the influence of different factors, such as FC type (isolated or syndromic), a diagnosed syndrome, extent of FC depression (second or third), and age, two biochemical variants of FC-variants a and b, which were not related to the presence or absence of a known concurrent syndrome, were distinguished. These variants differed from each other in all the parameters under study. Variant a occurred about five times less frequently than b, and was characterized by a pyridinoline content of about 50% of that of b, an elevated soluble:insoluble collagen ratio, and an increased percentage of endogenous collagenolysis compared to controls. For variant b, the pyridinoline content fell within normal limits, but the soluble:insoluble collagen ratio, and the percentage of endogenous collagenolysis were below normal. The data suggest that the formation of variant a may be related to defect(s) in collagen crosslinking, whereas the formation of variant b may result from other unknown factor(s) involved in the formation and maturation of costal cartilage.
[Funnel chest deformities: operative treatment (author's transl)].
The frequency of chest deformities is 1:100; operative treatment, however, is necessary in only 1:1000 patients with such a deformity. The most frequent deformity--in 91%--is the funnel chest. Chicken breast, combined types, and fissures of the sternum are seldom seen. Indications for operative treatment are: deformity of more than 25% of the normal sagittal diameter of the chest; heart failure and the degree of pathologic signs on the EKG; alterations of the vertebral column; psychologic aspects. Our operative procedure consists of double cartilage incision and stabilization of the chest with a metal strut.
[Anesthesiologic and postoperative complications in children with isolated forms of funnel chest].
In thoracoplasty for isolated funnel-shaped deformity of the chest in children, the main anesthesiologic complications which develop are the following: delayed restoration of muscular tonicity and adequate respiration and disorders in cardiac rhythm. At the postoperative period, the complications, are mainly caused by injury to parietal pleura at intervention. The pulmonary, cardiac, gastroenterologic and hemorrhagic complications were observed less often.
[Apropos of the treatment of funnel chest].
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Surgical correction of funnel chest.
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