Klinik und Problematik der Kiel- und Trichterbrust*

Abstract

Chest wall protrusion and depression deformities, also known as funnel chest and pigeon chest, are nosologically a uniform entity. Our own histopathological studies revealed secondary changes, found likewise in arthroses, scolioses, aseptic osteonecroses and inflammatory processes, as well as changes found in so-called primary collagenous diseases of unknown aetiology. Investigation of the collagen metabolism did not disclose differences from the normal II-type collagen either qualitatively or quantitatively. The aetiology of funnel chest and pigeon chest can be defined as follows: A hereditary disturbance of metabolism results in weakening of the wall of the parasternal cartilage, effecting a deformation secondary to mechanical strain by respiration and growth. Psychocosmetic reasons are recognised as indication for operation. In our opinion, the optimal age for operation is the second to the sixth year of life. During 20 years, 765 patients were operated on at our hospital without lethality. Postoperative complications were pneumothorax (4%), pneumonia (2%), after bleeding (2%) and disturbed wound healing (7%). Late results 5 years following surgery were excellent in 57%, good in 27%, satisfactory in 10% and unsatisfactory in 6% of the cases, thus adding up to 84% good results.

Surgical correction of pectus excavatum: the Münster experience

“…Lower rates of recurrence have been observed in many long-term studies after the correction of funnel chest [25][26][27]. Irrespective of the technique, we consider the main reasons for recurrence to be: (1) inadequate mobilization of the depressed chest wall (2) unstable fixation of the mobilized chest wall and (3) no or inadequate remodeling of the lowest parts of the deformed ribs [28].…”

Pectus excavatum, pectus carinatum and other forms of thoracic deformities

“…Lower rates of recurrence have been observed also in many longterm studies after the correction of funnel chest. [1,38,39,40,41] Irrespective of the technique, we consider the main reasons for recurrence are (a) inadequate mobilization of the depressed chest wall (b) unstable fixation of the mobilized chest wall and (c) no or inadequate remodeling of the lowest parts of the deformed ribs. [42] Complete exposure of sternum and ribs is necessary for satisfactory results as it allows complete intraoperative assessment of the deformity and is of significant importance in patients > 15 years of age who may require an additional transsternal strut because of the extensive area of sternal depression.…”

Die Trichterbrust - Krankheit oder Mythos

“…Während in der Anamnese immer unspezifische Probleme, wie Erkältung, Leistungsschwäche, Kurzatmigkeit und Herzstechen ge-nannt werden, können diese Symptome nicht durch Röntgenthoraxuntersuchungen, CTs, Lungenfunktionsuntersuchungen, Lungenszintigraphien, Echokardiographien oder auch durch Herzkatheter-und Pulmonaliskatheteruntersuchungen nachgewiesen werden. Hecker [6] berichtet über 94% gute und sehr gute Ergebnisse, Saxena [14] über 98,5% erfolgreiche Ergebnisse, Shamberger [15,16] über 97% sehr gute und gute Ergebnisse und Haller [4] über 94% gute und sehr gute Ergebnisse. Die Ergebnisse nach operativer Korrektur von Trichter-und Kielbrüsten sind in den größeren publizierten Serien einheitlich.…”