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The Journal of Cardiovascular Surgery 1999 Giugno;40(3):439-43

lingua: Inglese

Pro­tru­sion and ­mixed defor­mities

Keszler P., Szabò Gy. J.

From the ­National Insti­tute of Trau­ma­tology Buda­pest, Hun­gary


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Back­ground. Con­sid­er­able con­fu­sion is encoun­tered in the lit­er­a­ture ­relating clas­sifi­ca­tion ­respectively sur­gical ­repair of the ante­rior ­chest ­wall defor­mities in ­view of the asym­metric ­types ­which are arbi­trarily ­ranged in one of the two ­main ­groups (impres­sions, pro­tru­sions).
­Methods. Out of 420 oper­a­tions 89 (21%) ­were per­formed for ­pure pro­tru­sion, and 64 (15%) for ­mixed defor­mities, ­with asym­metric impres­sion and pro­tru­sion ­present at the ­same ­time. ­Mixed defor­mities ­were lim­ited to the par­a­sternal ­area in 10 and ­extended to the ­entire ante­rior ­chest ­wall in 54 ­cases. Sur­gery was under­taken for ­both pro­tru­sion and ­mixed defor­mities ­beyond 10 ­years of age in 9.8%, ­while for a typ­ical ­funnel ­chest defor­mity in 31% (p<0.001). Cor­rec­tion has ­been ­achieved per­forming ­double sub­per­i­chon­dral exci­sions of the dis­torted car­til­ages and — if nec­es­sary — sub­per­i­os­teal ­wedge inci­sion of the ­bony seg­ments, com­pleted by a T ­shape ­wedge ­sternal inci­sion. In ­order to pre­serve the ­repaired posi­tion a stain­less ­steel stab­i­liser was intro­duced for one ­year ­behind the ­sternum and the ­entire mob­il­ised ­wall ­area.
­Results and con­clu­sions. ­This ­method was ­used ­hitherto in 60 ­patients ­with ­mixed, ­respectively ­severe ­funnel ­chest defor­mities ­without any com­pli­ca­tion. The “­pectus ­index” cal­cu­lated ­according to the equa­tion A/B×100, in ­which A is the ­internal ­sterno-ver­te­bral dis­tance and B is the trans­verse diam­eter of the ­chest at the ­level of the dia­phragms in cm (­normal ­values: 35%-45%) was fol­lowed for 7.6±4.5 ­years in 63 ­patients. The pre­op­er­a­tive 53±7.6% ­decreased to 44.2±6.3% (p<0.05).

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