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ULTIMO FASCICOLOTHE JOURNAL OF CARDIOVASCULAR SURGERY

Rivista di Chirurgia Cardiaca, Vascolare e Toracica


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

THORACIC PAPERS 

 ORIGINAL ARTICLES

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

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.

lingua: Inglese


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