Chest wall anomalies: pectus excavatum and pectus carinatum

Goretsky, Michael J.; Kelly, Robert E.; Croitoru, Daniel P.; Nuss, Donald L.

doi:10.1016/j.admecli.2004.06.002

Cited by 187 publications

(184 citation statements)

References 31 publications

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“…Recurrence is rare in facilities with ample experience. (28) Recurrence tends to occur in children initially submitted to early or incomplete surgical correction. (27) Complications such as serous collection, hematoma, infection at…”

Section: Resultsmentioning

confidence: 99%

“…Resection is always bilateral, even in the asymmetric cases, since, on the side presenting preserved cartilages, the sternum will be pushed forward in the case of PC, and backward in PE, promoting the recurrence of the deformity. (28,29) The perichondrium is the germinative element of (i.e., produces) the cartilage, and the costal cartilage will therefore be restored in the new position within approximately 3 months; 5) the xiphoid process is released and should be resected when it is too angled; 6) in lower PC, the sternum typically assumes the normal position after chondrial resection, and osteotomy is not necessary. In PC, in which the sternum does not assume the correct position, in upper PC, and in PE, the osteotomy is required for the correction of the deformity.…”

Section: Modified Sternum Chondroplastymentioning

confidence: 99%

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Pectus carinatum

Coelho

Guimarães

2007

J. bras. pneumol.

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Among the deformities of the thoracic wall, pectus carinatum has not received the same attention as has pectus excavatum. Few pulmonologists, pediatricians, and thoracic surgeons are aware of the approaches to treating this condition. As a consequence, patients with pectus carinatum are not referred for treatment. This deformity, with an incidence of 1:1000 teenagers, is oligosymptomatic. However, for aesthetic and emotional reasons, it accounts for a large number of medical appointments. Such patients are introverted and do not engage in physical activities, since they are unwilling to expose their chest, which also discourages them from going to the beach or to swimming pools. The diagnosis is clinical and visual, and details are obtained through chest X-rays and computed tomography. The treatment is based on a well-known organogram that summarizes orthopedic and surgical procedures. Dynamic compression, combined with physical exercises, is indicated for teenagers with flexible thorax in inferior and lateral pectus carinatum, with limited indication for those with superior pectus carinatum. For individuals of any age with rigid thorax, surgery is indicated for aesthetic reasons. Among the techniques described, the modified sternum chondroplasty stands out due to the excellent aesthetic results achieved.

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Section: Resultsmentioning

confidence: 99%

Section: Modified Sternum Chondroplastymentioning

confidence: 99%

Pectus carinatum

Coelho

Guimarães

2007

J. bras. pneumol.

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“…Treatment was limited to fresh air, breathing exercises, aerobic activities and lateral pressures [27,28]. Surgical correction of pectus deformities dates back to the early 1900s, with corrective techniques proposed by Meyer and Sauerbruch [29,30]. In the decades that followed, Brown, Cook and other surgeons developed novel methods for repair, though their methods failed to gain popularity [31].…”

Section: Old Treatment Modalitiesmentioning

confidence: 99%

Advances in the management of pectus deformities in children

Swergold¹,

Sridharan²,

Loukas³

et al. 2013

OJPed

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Pectus excavatum (PE) and pectus carinatum (PC) are relatively common deformities involving the anterior chest wall, occurring in 1:1000 and 1:1500 live births, respectively. While the etiology remains an enigma, the association of pectus deformities with other skeletal abnormalities suggests that connective tissue disease may play a role in their pathogenesis. Clinical features of these deformities vary with severity, as determined by the Haller index and Backer ratio, but frequently include cardiac and respiratory abnormalities. Importantly, there exist profound psychosocial implications for children afflicted with these deformities, including but not limited to feelings of embarrassment and maladaptive social behaviors. These debilitating characteristics have prompted the development of novel medical and surgical corrective techniques. The correction of pectus deformities reduces the incidence of physiological complications secondary to chest wall malformation, while simultaneously improving body image and psychosocial development in the affected pediatric population. The Ravitch (open) and Nuss (minimally invasive) procedures remain the most frequently employed methods of pectus deformity repair, with no difference in overall complication rates, though individual complication rates vary with treatment. The Nuss procedure is associated with a higher rate of recurrence due to bar migration, hemothorax, and pneumothorax. Postoperative pain management is markedly more difficult in patients who have undergone Nuss repair. Patients undergoing the Ravitch procedure require less postoperative analgesia, but have longer operation times and a larger surgical scar. The cosmetic results of the Nuss procedure and its minimally invasive nature make it preferable to the Ravitch repair. Newer treatment modalities, including the vacuum bell, magnetic mini-mover procedure (3MP), and dynamic compression bracing (DCB) appear promising, and may ultimately provide effective methods of noninvasive repair. However, these modalities suffer from a lack of extensive published evidence, and the limited number of studies currently published fail to adequately define their long-term effectiveness.

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“…Patients report symptoms related to the deformity as exercise intolerance, shortness of breath, and weakness (2,6,7). Previously, it has been stated that the deformity did not cause physiological dysfunction (1,2).…”

Section: Introductionmentioning

confidence: 99%

“…It occurs in about one per 3-400 living born males and predominantly affects boys, with a 3-4:1 male dominance. The degree of the deformity varies among patients, but the majority of patients complain of the poor cosmetic appearance caused by the deformed sternum (1,2). PE may also impair restrict chest wall movement and impair cardiorespiratory function (3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

A prospective study on quality of life in youths after pectus excavatum correction

Lomholt

Jacobsen²,

Thastum

et al. 2016

Ann. Cardiothorac. Surg.

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Background: The impact of correction of pectus excavatum (PE) on adolescents' health-related quality of life (HRQL) has only been investigated in prospective designs using disease-specific measures and without controls. The aim of this prospective study was to evaluate the HRQL before and after surgical correction of PE using a generic HRQL measure, and to compare the reported level of HRQL before surgery with an age-comparable control group.Methods: Patients (n=107) and one of their parents (n=106) completed the generic HRQL measure: the Child Health Questionnaire before, 3 months, and 6 months after correction for PE. A control group (n=183) consisting of school children comparable in age completed the same measure on one occasion. Results:The patients' level of HRQL before surgery was comparable to the level of the controls except for physical functioning; here boys reported impaired function compared to controls (P<0.0001, d=0.72).Both patients and parents reported improved emotional wellbeing and self-esteem, as well as an increase in physical and social activities from pre-to post-surgery. These improvements were statistically significant (P≤0.001-0.03) and yielded moderate to high effect sizes (ƞ 2 =0.04-0.22). Conclusions:The improvement of physical and psychosocial HRQL reported by both patients and their parents as proxy indicates the psychological implications of the deformity. Patients reported impaired physical function compared to controls. Further, pre-surgery differences in HRQL between the patients and the controls were lacking. However, the improvement in the patients' HRQL following surgery may justify the correction of pectus excavatum. The effect of the deformity on patients wellbeing compared with controls' needs to be addressed in further studies.

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Chest wall anomalies: pectus excavatum and pectus carinatum

Cited by 187 publications

References 31 publications

Pectus carinatum

Pectus carinatum

Advances in the management of pectus deformities in children

A prospective study on quality of life in youths after pectus excavatum correction

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