Clinical experience of repair of pectus excavatum and carinatum deformities

Abstract

BackgroundWe present the results of surgical correction of pectus excavatum (PE) and pectus carinatum (PC) deformities in adults, and also report a new method of sternal support used in surgery for PE deformities.MethodsWe present the results of 77 patients between the ages of 10 and 29 years (mean 17) with PE (n = 46) or PC (n = 31) deformities undergoing corrective surgery from 2004 to 2011, using the Ravitch repair method. Symptoms of the patients included chest pain (15%) and tachycardia (8%). Three patients underwent repair of recurrent surgical conditions.ResultsAll of the patients with dyspnoea with exercise experienced marked improvement at five months post operation. Complications included pneumothorax in 5.1% (n = 4), haemothorax in 2.6% (n = 2), chest discomfort in 57% (n = 44), pleural effusion in 2.6% (n = 2), and sternal hypertrophic scar in 27% (n = 21) of patients. Mean hospitalisation was eight days. Pain was mild and intravenous analgesics were used for a mean of four days. There were no deaths. Results after surgical correction were very good or excellent in 62 patients (80%) at a mean follow up of three years. Three patients had recurrent PE and were repaired with the Nuss procedure. In three patients who underwent the Ravitch procedure, a stainless steel bar was used for sternal support instead of Kirschner wire.ConclusionsPectus deformities may be repaired with no mortality, low morbidity, very good cosmetic results and improvement in cardiological and respiratory symptoms.

Evaluation of sternochondroplasty efficacy in treatment of pectus deformities

“…In all patients, improvements in exercise tolerance with less dyspnea was reported after surgery: 74 had good physical activity at 6 months postoperatively, but 2 pectus excavatum patients and 1 pectus carinatum patient had a recurrence. 7 In our study, the most common symptom was exercise dyspnea, and 31 patients showed improvement in physical activity and cosmetic results postoperatively; 2 patients had recurrence of pectus excavatum.…”

“…Ravitch 6 was the pioneer of modern treatment for these deformities, pectus excavatum being corrected by resection of the elongated cartilage. In a retrospective study by Oncel and colleagues, 7 77 patients with pectus deformities were studied. The mean age of these patients was 17 years (range 10-22 years).…”

Impact of surgical treatment of pectus carinatum on cardiopulmonary function: a prospective study

“…Although most institutions perform a thorough evaluation of the patient, unfortunately few papers have reported full data on postinterventional spirometry and exercise performance [ 24–26 ] . Moreover, follow-up examinations were mainly performed as clinical evaluations, or via telephone or retrospective mail questionnaires, thus not providing objective data [ 25 ].…”

Which Variables Should be Considered as Confounders of p38-Mitogen Activated Protein Kinase Activation Measurements?

“…In their Letter to the Editor, Oncel and colleagues [4] noted that our recommendation that patients with a PI greater than 4.0, an asymmetrical defect, and calcified costal cartilages should not undergo a Nuss procedure for correction of pectus excavatum is contrary to their practice of successful Nuss procedures, in which "most patients with a pectus index of 6.0" and is superior to open surgical techniques in every aspect. Oncel and colleagues [4] referenced an article from their institution published in 2013 [5]. That series of 77 patients with pectus deformities was from 2004 through 2011 and they underwent repair with an open Ravitch procedure and a K-wire for posterior sternal support.…”

“…Concomitant pharmacologic treatments have influences on signalling pathways, and indeed glucocorticoids have been used as antiinflammatory agents clinically modulating signalling cascades [3]. However, methylprednisolone does not appear to alter the effect of CPB on p38 MAP kinase phosphorylation in right atrial tissue [4] and other drugs commonly given to cardiothoracic surgical patients (eg, aspirin [5], statins [6], angiotensin converting enzyme inhibitors [7], antidiabetes medication [8] and analgesics [9]), have influences on immune signalling.…”