[Funnel chest and the funnel chest operation: effects on the heart, hemodynamics and lung].
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Female↗
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[A simple surgical technic for funnel chest; experiences with plastic surgery for funnel chest associated with heart defects].
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Adolescent↗
[Psychological and cosmetic indications for the surgery of funnel chest].
From 1980-1983 the funnel chest of 29 patients (age range 6-40 years) was surgically corrected using Ravitch's method. In 25 patients clinical and cosmetic follow-up investigations were possible. The psychological investigation consisted of standardised interviews with special questions concerning the problems that patients with funnel chest have to deal with. In 16 cases the result of the operation was good, in 7 cases satisfying, 2 patients had a poor result. The presence of a funnel chest did have a psychological impact on most of the patients, who were inhibited in their psychosocial activities. Surgical correction changed these restrictions in most of the patients in a positive way. We conclude that the psychosocial indication for surgical correction of the funnel chest is justified, since our results strongly support this indication.
Adolescent↗
[Indications and surgical technic for the correction of funnel chest and its results].
Treatment of funnel chest is only successful by surgical means. 425 funnel chest operations have been performed between 1956 and 1974 at the Surgical and Paediatric Surgical Department of the University Erlangen-Nürnberg. Different types of operative procedures have been compared with each other. The internal fixation of the elevated funnel chest with a metal strut is an operative procedure with the lowest infection rate, with less recurrences and the best anatomical and cosmetic results. The surgical procedure involves a double incision of the ribs parasternally and at the borderline of the funnel, the mobilised ventral part of the chest is elevated by a metal strut to an anatomically normal position. 235 patients have been operated on by this method. In 7% a local wound infection occured, there was one total recurrence and 15 partial recurrences. 4 years after operation 75% of the patients had an anatomically normal and well developed chest with an excellent cosmetic result.
Child↗
Instrumentation surgery for funnel chest.
Thirty four patients with funnel chest were operated on using the Zimmer plate and/or U shaped rod. There were no recurrences of the chest deformity and 78.6% were satisfied with the result. The low % VC significantly improved after the operation. Five cases had one of the following complications, massive bleeding from the internal thoracic artery, partial skin necrosis, rotational dislodgement of the rod, temporal subcutaneous infection or partial rupture of the pectoral muscle incision. The blood loss ensuing in one operation during the last 8 years has been less than 300 ml and the postoperative bed rest was less than 7 days. All the patients could get back to the preoperative daily activities within three weeks without wearing brace or chest protector. Therefore, our method is considered to be less invasive and very useful for correction of the funnel chest deformity.
Adolescent↗
[Early diagnosis of progression of funnel chest in children].
104 patients with progressive forms of funnel chest deformity of the II-III degree with Ehlers-Danlos-Marfan syndrome, Marfan-like phenotype, isolated funnel chest deformity and unclassified funnel chest deformity of the first degree were subjected to synromologic examination. There were detected 10 dysplastic signs, indicating funnel chest deformity progression: anti-Mongol shape of the eyes, arachnodactyly, high palate, Ehlers-Danlos syndrome, floor of the auricle's dysplasia, dolichostenomely, posture disturbance, mitral valve prolapse, umbilical hernia, wide filter. The results of biochemical examination of collagen metabolite--hydroxyproline++ (the first and the second hydroxyproline++ fraction ratio disturbance, decrease of the first hydroxyproline++ fraction percentage, disturbance of direct correlation between total hydroxyproline++ and percentage of the first hydroxyproline++ fraction)--corroborated the clinical data.
Adolescent↗
[Effect of subtotal resection of costal cartilage on the basic chest dimensions in children with funnel chest deformity].
The paper summarizes the results of anthropometric and computed tomographic studies of the external and internal chest dimensions in 86 patients with Degree II-III infundibuliform chest deformity. Full resection of deformed cartilages of the third to seventh ribs has been examined for its impact. The children with infundibuliform chest deformity have been found to have an impressed anteroposterior dimension of the bilateral chest. The transversal and anteroposterior dimensions of the chest remain unchanged after removal of cartilages. The chest enlarges only sagittaly. One- and three-year follow-ups have indicated that full removal of the deformed cartilage has no impact on the growth of the chest.
Adolescent↗
Unusual combination of pulmonary sequestration and funnel chest.
Cases of pulmonary sequestration and cases of funnel chest are frequently accompanied by other anomalies, although the combination of pulmonary sequestration and funnel chest is rare. In this study, we report ten cases of pulmonary sequestration, nine of which had the combination of pulmonary sequestration and other anomalies; four evidenced the unusual combination of pulmonary sequestration and funnel chest.
Abnormalities, Multiple↗
[Funnel chest and pigeon breast (author's transl)].
The dominant heredity of funnel chest formation is considered proved. The incidence of funnel chest is about 0.05% of the population, with the emphasis on boys. In very many cases deformities of the anterior chest wall are associated with other deformities. All patients with pigeon breast or funnel chest suffer considerably psychically under their deformity. This is the main indication for operation. The best age for operation is from the 2nd to 6th years of life. Conservative methods of treatment are never successful. Of the present day operative techniques, the stabilizing--by implantation of metal clips--are opposed to the nonstabilizing operative procedures. Both achieve equally good and completely satisfactory results in 85% of cases.
Abnormalities, Multiple↗
[Treatment of funnel chest with RTV-silicone implants].
The funnel chest is no physiological but a psychological problem for the majority of patients. Only 5% suffer from pathological parameters which require a surgical elevation of the funnel. After these rather complicated operations, however, only 60-80% are followed by good long-term results. The described RTV-silicone implant is formed preoperatively directly in the funnel and appears to be a simple safe and lasting alternative for most patients with a funnel chest.
Adolescent↗
[Urinary excretion of hydroxyproline in funnel chest deformity].
Excretion of hydroxyproline with urine was studied in 16 children with localized form of funnel chest deformation simultaneously with Marfan and Ehlers-Danlos syndromes, in 9 children with the localized form of deformation within 6-8 months after thorax surgical plastic operation as well as in 3 children with Ehlers-Danlos syndrome but without funnel chest deformation. Funnel chest deformation of the II-III degree, independently of its form, was accompanied by a decrease of total hydroxyproline in urine as compared with healthy children of the similar age. The hydroxyproline excretion was normalized after thoracoplastic operation in the children with localized form of the chest deformation. In Ehlers-Danlos syndrome, independently on presence or absence of the chest deformation, relative content of free hydroxyproline was increased in urine, while the peptide-bound amino acid was decreased (peptides with molecular mass above 700 daltons); this phenomenon appears to be a characteristic property of the syndrome.
Adolescent↗
[Modified Ravitch operation in the treatment of patients with funnel chest].
The characteristic traits of funnel chest have been presented and the clinical results of surgical treatment in 13 patients by the modified Ravitch method have been discussed. Nine results were excellent and four results were good. A marked improvement of general physical function of the patients due to the increase of respiratory system efficiency and a good cosmetic effect were found. The modification of the operation consists in additional longitudinal osteotomy of the sternum, suturing of the manubrium to the sternum shaft, non-suturing of the rib cartilages after resection, filling of the through-like groove in the reposited sternum with the fragments of the resected rib cartilages, and immobilization of the fragments of the longitudinally osteotomized sternum that are inserted crosswise with several (usually three) Kirschner wires, based on the thorax.
Adolescent↗
Familial congenital funnel chest.
We observed three Chinese families in which congenital isolated funnel chest was segregating. This report confirms that funnel chest (pectus excavatum) can be transmitted as an autosomal dominant trait.
Funnel Chest↗
[Phono- and echocardiographic studies of the genesis of mitral valve prolapse in patients with funnel chest].
Two-dimensional echocardiograms (2-DE) and phonocardiograms (PCG) were used to clarify the genesis of mitral valve prolapse (MVP) and mitral regurgitation (MR) in 44 patients with funnel chest. These patients were categorized in three groups on the basis of the fronto-sagittal index (FSI) as determined from chest radiographs; 17 as mild, 15 as moderate and 12 as severe funnel chest. Their ages ranged from 5 to 65 years and averaged 24 years. MVP was diagnosed using the long-axis view of the 2-DE, and MR was diagnosed phonocardiographically including provocative test using angiotensin II. The results were as follows: In 44 patients with funnel chest, 20 (45%) had MVP and 15 (34%) had MR, respectively. The incidence of MVP increased directly in proportion to the severity of index, but the incidence of MR did not. In the short-axis view of the left ventricle at the level of the papillary muscles, there was more marked flattening of the interventricular septum than of the left ventricular posterior wall, resulting in deformity of the left ventricular geometry. A distortion index (DI) was used to quantify the degree of distortion of left ventricular shape, calculated as follows: DI = (R-r)/r, where R and r were radii of the curvatures of the interventricular septum and the left ventricular posterior wall, respectively. The DI in end-diastole (DId) and end-systole (DIs) increased in proportion to the severity of funnel chest. Patients were subdivided into four groups on the basis of DId. Incidence of MVP increased in proportion to the degree of distortion of the left ventricular shape. There was, however, no significant difference in the incidence of MR among the four groups. Patients were subdivided; one group of 13 under 14 years of age; another, 31 over 15 years old. The incidence was much higher in the latter than the former, but the incidence of MVP increased in proportion to the severity of funnel chest in both groups. MR was complicated by MR in nearly all cases in the latter group, but none had MR in the former. The DI of patients, whose FSI improved with surgery, apparently improved in addition to the disappearance and/or improvement of their MVP and MR. However, patients whose FSI did not improve with surgery showed little change in DI and persistence of MVP and/or MR.(ABSTRACT TRUNCATED AT 400 WORDS)
Adolescent↗
[Funnel chest: objective and subjective aspects].
Forty cases of funnel chests were observed in a majority of 15-20 years old male youngsters. Twenty-six had respiratory or cardiac symptoms. A surgical correction was done for 22 patients; 12 had symptoms. Eighteen patients had no surgery and were advised to undertake physical therapy: 6 had symptoms. With a 1 to 25 years follow-up 12 operated patients were checked up: 10 were satisfied with the correction. None had any symptom. This subjective results were superior to the morphologic and functional criteria. As for non operated patients, 12 were contacted: 7 had followed our advice and felt a functional amelioration in 6 cases and a morphological amelioration in 4 cases. Five patients had no therapy: 4 considered themselves in a stable situation an 1 thought it was worse. Funnel chest symptoms are the expression of anxiety in a majority of cases. The subjective as well as the formal matters are to be considered to appreciate the results of treatment. Physical exercises are an important part of the therapy, either with or without surgery.
Adolescent↗
[Operative corrections of funnel chest depend on age group].
The methods of correcting funnel chest are various and many. It's necessary to select the proper method depending on the age group. For children, sternal elevation by Ravitch's procedure produces to better results without prosthesis. For adolescent patients, the elevated sternum can be maintained by Kirschner's wires. Furthermore, adult patients have severe chest wall deformities with calcificated costal cartilage. The methods sternal elevation methods cause an unsatisfactory by postoperative appearance for adult patients with funnel chest. Two adult patients, 20 and 48-year-old men, underwent the sternal turnover methods with complete sternal blood supplies. The procedures of the new method turn over the sternal body crossing bilateral internal thoracic vessels and abdominal rectal muscles. No chest wall deformities were seen and the patency of internal thoracic arteries and superior epigastric arteries was revealed by postoperative arteriography.
Adolescent↗
[Anomalies of the chest wall, with special reference to funnel chest].
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Adolescent↗
[Objective determination of the shape of the anterior chest wall using moiré topography. Method and development of dimension-free indices for the evaluation of funnel chest].
Stereophotogrammetric measurement of body surface results in data, which are dependent on shape, posture and positioning of the patient. In order to establish a valid description and characterization of funnel chest measured by stereophotogrammetric methods, index numbers must be defined, which are independent of posture und positioning of the patient. This procedure is exemplified in the analysis of moiré topograms from 29 patients with funnel chest and 21 normal persons. The sagittal cross section is characterized by the index TI I, which in essential is the sum of absolute values of angles in a polygon along the section (cf. fig. 7). The funnel in the coronal cross section is characterized by the index TI II, which gives the quotient (in %) of the mean funnel width and funnel depth (cf. fig. 8). Application of the index numbers shows a good differentiation of TI I, independent of sex, whereas TI II might be most useful in follow up measurements.
Adolescent↗