1/114. 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. ( info) |
2/114. Repair of pediatric pectus deformity and congenital heart disease as a combined procedure. Coexisting pectus deformity and congenital heart disease is not uncommon. Traditionally, the approach to this problem has been to repair each one with a separate surgical procedure because of fear of increased complications from bleeding, infections, and anesthesia. More recently, many reports of successful combined repair have been published, particularly in adults with coronary artery or aortic pathology. The authors wished to determine the feasibility of this combined procedure in younger patients, particularly those with a severe pectus deformity. Three patients underwent repair, including a 17 year old with Marfan's syndrome and a severe pectus excavatum deformity. The postoperative course was smooth for these patients, and all had good short- and long-term (over 18 months) results. ( info) |
3/114. 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. ( info) |
4/114. 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. ( info) |
5/114. 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. ( info) |
6/114. Interesting inferior vena cava. This article presents, as diagnostic problems, computed tomographic (CT) images from a patient with unusual cross-sectional anatomy at the thoraco-abdominal region. The introduction and discussion emphasize the solution and explain the underlying clinical condition and resultant radiographic and computed tomographic imaging features. ( info) |
7/114. 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. ( info) |
8/114. Combined repair of pectus excavatum and coronary artery bypass grafting. coronary artery bypass grafting (CABG) in patients with severe pectus excavatum is a surgical challenge. A two-stage correction of sternal deformities and cardiac lesions has been described and myocardial revascularization through a left lateral thoracotomy is a valid alternative in urgent situations. We report a one-stage repair of severe pectus excavatum and CABG with the use of bilateral internal thoracic arteries in a young patient requiring urgent myocardial revascularization. The technical aspects and operative consideration are discussed. ( info) |
9/114. 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. ( info) |
10/114. Spondylothoracic dysplasia with diaphragmatic defect: a case report with literature review. Spondylothoracic dysplasia (Jarcho-Levin syndrome) is a syndrome of unknown etiology. We describe a new case with diaphragmatic eventration. literature review for cases of Jarcho-Levin syndrome with diaphragmatic defects, which were six cases, revealed that renal affection increased when diaphragmatic defects associate the syndrome with pulmonary hypoplasia. Thus, the subgroup of spondylothoracic dysplasia with diaphragmatic defect is a more severe subgroup of the syndrome rather than the other forms of this syndrome. Relating the described anomalies in this case and that of the literature cases to the known embryological basis may point to a pivotal developmental link between lung, kidney and diaphragm, possibly the posterior mesenchyme. ( info) |