1/52. A new method of reconstruction for pectus excavatum that preserves blood supply and costal cartilage.We began in 1982 to use a modified Ravitch procedure that preserves the blood supply to the sternum to correct funnel chest deformities, but there were some problems such as postoperative paradoxical respiration, chest wall irregularity, and palpable heart beat. To resolve these problems, the concept of Jensen's procedure was incorporated into the authors' previous method. In Jensen's method, only a small portion of the deformed cartilages is resected, and almost all of them are preserved. A preformed stainless steel strut is used for chest wall stabilization. The authors preserved the costal cartilages in a manner similar to Jensen's, but the anterior chest wall was stabilized with miniplates and Kirschner wires instead of a large retrosternal strut. The xiphoid process with the lower end of the sternum was detached and moved cephalad. None of the patients developed respiratory failure postoperatively. Although the follow-up periods were short, satisfactory results were obtained with no recurrence of the deformities. The main advantages of our procedure are (1) basic blood supply to the chest wall is preserved, (2) stability of corrected chest wall is maintained with miniplates and Kirschner wires without a large metallic strut, and (3) preserved costal cartilages make the chest wall rigid and the incidence of respiratory failure low. We conclude that this method is simple and produces satisfactory results with a rigid chest wall.- - - - - - - - - - ranking = 1keywords = chest (Clic here for more details about this article) |
2/52. Revascularization of turnover sternum: A definitive treatment for intractable funnel chest.Twelve intractable funnel chests in young adults were treated with revascularization of the turnover sternum. The sternum and costal composite tissue were resected at the outskirt of the depressed area. Special attention was paid to the dissection of the vascular pedicle at both sides of the internal mammary vessels. The recipient vessels at one side were left long, so were the donor vessels at the other side. A segment of the rib at the exit of the recipient internal mammary vessels had to be removed to accommodate the vessels and to facilitate vascular anastomosis. Vascular anastomosis was accomplished with loupes (Keeler, sixfold magnification) in five patients because the direction of the vessels is vertically oriented. In four cases, artery and vein grafts were taken from the other side of the internal mammary vessels not bound for vascular anastomosis for length discrepancy of the vessels, while the remaining cases had direct vascular anastomosis without vascular grafting. Revascularization of the turnover sternum was performed successfully without vascular compromise. The patients all recovered well with much improved physical condition. Only one patient sustained spontaneous pneumothorax 1 month after the operation. Postoperative three-dimensional computed tomographic (CT) scan revealed increment of thoracic cage volume for 9-17%. Follow-up CT scan 2 years later revealed even more improved thoracic cage expansion.- - - - - - - - - - ranking = 0.625keywords = chest (Clic here for more details about this article) |
3/52. Coronary revascularization without cardiopulmonary bypass in patients with pectus excavatum.BACKGROUND: Coronary revascularization in patients with pectus excavatum is technically difficult through a median sternotomy secondary to the posterior displacement of the sternum and the asymmetric angulation that it produces. The role of minimally invasive coronary artery bypass grafting (MIDCABG) in this subset of patients was evaluated. methods: In 1998, four patients with pectus excavatum underwent revascularization of the left anterior descending artery without cardiopulmonary bypass through a left anterior minithoracotomy. RESULTS: All patients underwent the procedure without intraoperative complications and postoperative angiography demonstrated adequate graft patency. CONCLUSIONS: The advantages of MIDCABG in patients with pectus excavatum is the superior exposure to the LAD and LIMA and avoidance of a median sternotomy and cardiopulmonary bypass. This procedure is deemed safe and effective in patients with such deformities of the chest wall.- - - - - - - - - - ranking = 0.125keywords = chest (Clic here for more details about this article) |
4/52. A complication of pectus excavatum operation: endomyocardial steel strut.An 18-year-old patient who had correction of pectus excavatum deformity in our department 4 years earlier was admitted because of stabbing chest pain. He had not attended to postoperative controls and had not come for extraction of the steel strut, although he had been contacted. He was diagnosed to have a broken steel strut, and the strut was noted to be embedded in the myocardium. This unreported complication of pectus excavatum operation forced us to review sternal support techniques.- - - - - - - - - - ranking = 0.12510731928413keywords = chest, pain (Clic here for more details about this article) |
5/52. Simultaneous repair of cardiovascular disorders and pectus deformity in a patient with Sprintzen-Goldberg syndrome: A case report.We report a 12-year-old girl with Sprintzen-Goldberg syndrome (SGS) who was complicated with annuloaortic ectasia with aortic regurgitation, mitral valve prolapse with mitral regurgitation, and a severe pectus excavatum. In this patient, aortic root replacement, mitral valve replacement, and sternal elevation were simultaneously performed, and a version of Ravitch's procedure that was technically modified to support the sternum was used for sternal elevation. This modified sternal elevation technique gave excellent operative exposure, and maintained chest wall stability after the operation.- - - - - - - - - - ranking = 0.125keywords = chest (Clic here for more details about this article) |
6/52. Major complications after minimally invasive repair of pectus excavatum: case reports.BACKGROUND/PURPOSE: A recently introduced technique allows for minimally invasive repair of pectus excavatum deformity. Successful application of the procedure has been reported by several centers. The purpose of this report is to describe the occurrence of 3 major complications in 5 patients. methods: These cases are taken from the combined experience of 3 surgeons at different institutions. Operative technique and postoperative management was not uniform. RESULTS: The first complication was cardiac perforation requiring repair. This occurred in an 8-year-old boy who had hemorrhage immediately after transthoracic placement of the clamp. He required urgent sternotomy with right atrial, and right ventricle repair followed by tricuspid valve repair on cardiopulmonary bypass. The second complication is staphylococcal sepsis, bilateral empyema thoracis, and bacterial pericarditis. This 13-year-old boy required bilateral pleural debridement followed 2 days later by open debridement of his heart. The final complication is thoracic outlet syndrome. These patients, age 12, 14, and 15, experienced persistent parasthesias in one upper extremity. One case was further complicated by instability of the bar requiring removal. In the other 2 patients, the symptoms resolved within 4 weeks with the bar in place. CONCLUSIONS: Minimally invasive pectus repair is a new surgical procedure. The spectrum and rate of complications is still emerging. Thorough and critical evaluation of the combined experience from many centers is essential to evaluate fully this novel approach to pectus repair.- - - - - - - - - - ranking = 5.0339484984611E-5keywords = upper (Clic here for more details about this article) |
7/52. Correction of pectus excavatum using a sternal elevator: preliminary report.Operative procedures to correct the deformity caused by pectus excavatum are generally based on either sternal elevation or turnover. In either case, the operation is highly invasive. By considering the softness of the costal cartilages in early childhood, we have developed an endoscopically assisted procedure that applies external traction continuously in order to elevate the depressed sternum and costal cartilages. Since August 1993, we have performed this operation in 11 patients with pectus excavatum who ranged in age from 3 years 1 month to 28 years. The traction screws came loose spontaneously in two early cases. Augmentation transfer of a latissimus dorsi muscle flap and dermal fat grafting were subsequently performed in these two patients, respectively. We achieved an excellent cosmetic outcome in the other nine patients, with results similar to those achieved with the conventional operation. Our technique is a two-stage procedure and the patient is limited in performing daily activities while wearing the traction device. Despite this drawback it can achieve permanent correction of the deformity. Accordingly, this method should be considered when pectus excavatum is corrected surgically, particularly in infants and young children.- - - - - - - - - - ranking = 0.0002587747236755keywords = back (Clic here for more details about this article) |
8/52. Severe pectus excavatum associated with cor pulmonale and chronic respiratory acidosis in a young woman.Pectus excavatum has never been reported to cause hypercapnic respiratory failure. In this report, we describe the first such case in a young woman with severe pectus excavatum who presented with chronic respiratory acidosis, pulmonary hypertension, and chronic cor pulmonale. An extensive diagnostic workup failed to uncover any other cause of respiratory acidosis, which led us to conclude that the severe chest wall deformity and the resulting severe restrictive defect were responsible for the development of chronic respiratory acidosis and cor pulmonale.- - - - - - - - - - ranking = 0.125keywords = chest (Clic here for more details about this article) |
9/52. Endoscopically assisted pectus excavatum repair.We present an endoscopic approach for the reconstruction of pectus excavatum with a custom silicone implant. The procedure incorporates endoscopic techniques to facilitate dissection of an extensive subcutaneous pocket through a 6-cm Chevron skin incision 8 cm below the level of the xiphoid. The incision is designed based on the size, shape, and flexibility of the custom implant and the configuration of the chest wall deformity. A superiorly based rectus abdominis anterior fascial sheath flap then is elevated up to the caudal-most margin of the implant, creating a sling below the implant, thus stabilizing its position and preventing direct communication with the overlying skin incision. In our patient, the endoscope permitted insertion of the custom implant while minimizing the length of incision. The cosmetic result using a minimally invasive approach to assist with the dissection was acceptable, and the morbidity and scarring were minimized.- - - - - - - - - - ranking = 0.125keywords = chest (Clic here for more details about this article) |
10/52. The potential use of intensity modulated radiotherapy (IMRT) in women with pectus excavatum desiring breast-conserving therapy.The purpose of this study was to determine if intensity modulated radiation therapy (IMRT) offers a better treatment plan compared to conventional radiotherapy for patients with pectus excavatum desiring breast-conserving therapy and to assess the feasibility of simultaneous modulated accelerated radiation therapy (SMART) boost. A patient with pectus excavatum desired breast-conserving therapy for her early stage breast cancer. She underwent lumpectomy and axillary lymph node dissection followed by chemotherapy. She was then referred for radiotherapy. A breast board (Med-Tec) with aquaplast body cast was used to limit the movement of the patient, chest wall, and breasts before planning a computed tomography (CT) scan. IMRT including dose-volume histogram (DVH) was compared to that of the conventional plan using parallel opposed tangential beams with a 15-degree wedge pair. Forty-five gray was prescribed to the whole breast to each plan, while 50 Gy was prescribed to the tumor bed using IMRT with SMART boost in 25 fractions over 5 weeks. The coverage of the whole breast was adequate for both plans. IMRT allowed a more homogeneous dose distribution within the breast at the desired dose range. With IMRT there is less volume of ipsilateral lung receiving the radiation dose that is above the tolerance threshold of 15 Gy when compared to that of the conventional plan. However, there is more volume of surrounding normal tissues (the heart, spinal cord, and contralateral breast and lung) receiving low-dose irradiation when IMRT was employed. SMART boost was feasible, allowing a mean dose of 57 Gy to be delivered to the tumor bed simultaneously along with the rest of the breast in 5 weeks. IMRT is feasible in treating early breast cancer patients with pectus excavatum by decreasing the ipsilateral lung volume receiving high-dose radiation when compared to the conventional method. SMART boost shortens the overall treatment time that may have potential radiobiological benefit.- - - - - - - - - - ranking = 0.125keywords = chest (Clic here for more details about this article) |
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