Surgical correction of pectus excavatum: the Münster experience

Abstract

Significant reduction in postoperative cardiorespiratory disorders, low lethality, improvement of subjective complaints, satisfactory long-term results and improvement in psychological problems indicate the need to offer this method of surgical correction to low-risk children.

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.…”

“…Although, surgical correction has been performed in many centers mainly for esthetic and psy-chological reasons, however, compression and secondary changes of the intrathroracic organs have been indications for surgery. [1] [ Figure 1] Many individual patients reported with specific cardiac problems, such as supraventricular tachycardias and recurrent heart failure, were relieved by correction of the depressed sternum.…”

HISTORY OF CARDIAC AND THORACIC SURGERY A historical outline of surgical treatment for congenital chest wall deformities

“…Asymmetrical deformity with normal sternal position, forward displacement of the costal cartilages on one side, and normal or concave positioning of the cartilages on the other side is less commonly encountered [7]. Finally, the least frequently described form of the defect consists in the protrusion of the episternum with a corresponding depression of the mesosternum or the xiphoid process [7,8].…”

“…In 1872, C. Williams wrote about a 17-year-old patient with pectus excavatum, whose father and brother had a similar defect [13]. However, the first to describe pectus excavatum was Eggel in 1870 [7]. Numerous reports of chest deformities were published in the 19 th century, including the work of W. Ebstein (1836-1912) from 1882, in which he presented 5 cases of patients whose recommended treatment was fresh air, breathing exercises, aerobic activities, and lying in the lateral position [14,15].…”

“…The defect may also take the form of an asymmetrical sternal depression with sternal rotation (15%), a shallow and extensive depression of the anterior chest wall (8-22%), or it may be a part of a combined pectus carinatum/excavatum deformity (2%) [7]. Among the less frequent types of the pectus carinatum defect, the forward displacement of the mesosternum, accompanied by bilateral, symmetrical protrusion of costal cartilages, is observed most often [7]. It was termed "chondrogladiolar" or "lower protrusion" by H. Brodkin [8].…”