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The Journal of Cardiovascular Surgery 1998 October;39(5):683-88

Copyright © 2000 EDIZIONI MINERVA MEDICA

lingua: Inglese

Long-term results after correction of anterior chest wall deformities

Lacquet L. K., Morshuis W. J., Folgering H. T.

From the Department of Thoracic and Cardiac Surgery University Hospital St. Radboud,Nijmegen University Lung Centre Dekkerswald, Groesbeek The Netherlands


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Back­ground. Sur­gical cor­rec­tion of ­pectus defor­mities was ­mainly per­formed for cos­metic and psy­cho­logic rea­sons but even­tual car­di­o­pul­mo­nary symp­toms ­improved. ­Whether ­this ­results ­from alter­a­tions in car­di­o­pul­mo­nary phys­iology is ­still con­tro­ver­sial.
­Methods. In 25 ­years 662 ­patients under­went cor­rec­tion (390 for ­pectus exca­vatum-­funnel ­chest, 235 for ­pectus car­i­natum-chicken ­chest, 37 for ­pectus ­arcuatum -­pouter ­pigeon ­chest). Sur­gical cor­rec­tion was ­mainly per­formed for cos­metic and psy­cho­logic rea­sons. Ster­no­chon­dro­plasty was per­formed ­without pros­thetic mate­rial.
­Results. Clin­ical ­results for ­funnel ­chest ­were sat­is­fac­tory in 83.6% (excel­lent 44.1%, ­good 39.5%) and ­were ­always ­good for pro­tru­sion defor­mities if ­enough ­deformed car­til­ages ­were ­resected. In a ret­ro­spec­tive ­study the pul­mo­nary func­tion ­tests per­formed on 152 ­patients ­with ­funnel ­chest ­before sur­gery and at ­long-­term ­follow-up dem­on­strated an even­tual ­increased restric­tion at ­follow-up, ­despite symp­to­matic improve­ment and ­increased ante­ro­pos­terior ­chest diam­eter on the X-ray, but ­restricted ante­rior ­chest ­wall ­motion. In a pros­pec­tive ­study the exer­cise car­di­o­res­pir­a­tory func­tion ­tests on 35 ­patients ­with ­funnel ­chest ­before and one ­year ­after oper­a­tion sug­gested ­unchanged ­work per­for­mance, but an ­increased ­oxygen con­sump­tion and acid­ifi­ca­tion due to a ­higher ­work of ­breathing ­after oper­a­tion, ­caused by ­decreased ­chest ­wall com­pli­ance.
Con­clu­sions. The sub­jec­tive phys­ical improve­ment ­after oper­a­tion ­cannot be ­explained by ­changes in ­static ­lung vol­umes or in car­di­o­res­pir­a­tory func­tion at exer­cise, but is due to ­other unex­plained fac­tors. Sat­is­fac­tory sub­jec­tive ­long-­term ­results of ­most ­patients jus­tify sur­gical cor­rec­tion. ­Both phys­ical as ­well as psy­cho­logic and cos­metic fac­tors may ­allow oper­a­tive cor­rec­tion.

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