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Rivista di Chirurgia Cardiaca, Vascolare e Toracica

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The Journal of Cardiovascular Surgery 1999 April;40(2):289-97

lingua: Inglese

Pectus exca­va­tum: spe­cial sur­gi­cal tech­nique, per­i­op­er­a­tive man­age­ment and ­long-­term ­results

Tjan T. D. T., Semik M., Rotering H., Rolf N. *, Scheld H. H.

From the Department of Thoracic and Cardiovascular Surgery * Department of Anesthesiology and Operative Intensive Care Medicine Westfaelische Wilhelm University, Muenster, Germany


Background. It is gen­er­al­ly accept­ed ­that pec­tus exca­va­tum ­should be ­repaired in child­hood if pos­sible. The pro­ce­dure ­could be per­formed con­ven­ient­ly ­even with­out implan­ta­tion of any for­eign mate­ri­al. In con­trast ­there are sev­er­al ­adult ­patients ­with aes­then­ic or mar­fan­oid hab­it­us and ­poor tho­rax cos­met­ics, who seek med­i­cal ­help espe­cial­ly sur­gi­cal cor­rec­tion due to ­late aware­ness or car­di­o­pul­mo­nary dys­func­tion.
Methods. Between 1989 and 1997, 22 ­adult ­patients (mean age 26 ­years, 18 ­males and 4 ­females) under­went ­repair of the pec­tus exca­va­tum in our insti­tu­tion. Patients ­data ­were ana­lysed ret­ro­spec­tive­ly. Indication was main­ly for aes­thet­ics or car­di­o­pul­mo­nary symp­toms, in 3 ­patients for recur­rence ­after pri­mary ­repair else­where. The ­total sur­gi­cal ­repair tech­nique con­sist­ed of V-­shape oste­ot­o­my of the ­ribs at the out­er and ­inner lim­it of the fun­nel and trans­verse oste­ot­o­my of the ster­num with­out dis­place­ment of the pos­te­ri­or cor­ti­cal. The ster­nal and ­chest ­wall sta­bil­iza­tion in cor­rect­ed posi­tion was per­formed ­with at ­least two met­al ­struts ­installed trans­ster­nal and trans­verse­ly. In ­most of our cas­es ­other diag­o­nal ­struts on ­both ­sides ­were need­ed to ­achieve fur­ther sta­bil­iza­tion of the low­est ­costal car­til­ag­es. The met­al ­struts are ­removed 1 ­year ­after the pro­ce­dure.
Results. All ­repairs ­were com­plet­ed ­with a low com­pli­ca­tion ­rate. Chest radio­graphs and pul­mo­nary func­tion stud­ies ­were per­formed rou­tine­ly ­before and ­after cor­rec­tive sur­gery. Good to sat­is­fac­to­ry ­chest con­tour was ­­achieved in 20 ­patients (91%), ­with a fol­low-up ­from 5 ­months to 8 ­years.
Conclusions. Our cur­rent tech­nique ­with per­i­op­er­a­tive man­age­ment is suc­cess­ful­ly per­formed in ­adults and ­will be pre­sent­ed.

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