[Funnel chest and the funnel chest operation: effects on the heart, hemodynamics and lung].
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Female↗
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Results for “FUNNEL CHEST”
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[A simple surgical technic for funnel chest; experiences with plastic surgery for funnel chest associated with heart defects].
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Adolescent↗
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.
Adolescent↗
[Psychological and cosmetic indications for the surgery of funnel chest].
From 1980-1983 the funnel chest of 29 patients (age range 6-40 years) was surgically corrected using Ravitch's method. In 25 patients clinical and cosmetic follow-up investigations were possible. The psychological investigation consisted of standardised interviews with special questions concerning the problems that patients with funnel chest have to deal with. In 16 cases the result of the operation was good, in 7 cases satisfying, 2 patients had a poor result. The presence of a funnel chest did have a psychological impact on most of the patients, who were inhibited in their psychosocial activities. Surgical correction changed these restrictions in most of the patients in a positive way. We conclude that the psychosocial indication for surgical correction of the funnel chest is justified, since our results strongly support this indication.
Adolescent↗
[On stabilization of the chest wall after surgery in funnel chest].
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Funnel Chest↗
[Indications and surgical technic for the correction of funnel chest and its results].
Treatment of funnel chest is only successful by surgical means. 425 funnel chest operations have been performed between 1956 and 1974 at the Surgical and Paediatric Surgical Department of the University Erlangen-Nürnberg. Different types of operative procedures have been compared with each other. The internal fixation of the elevated funnel chest with a metal strut is an operative procedure with the lowest infection rate, with less recurrences and the best anatomical and cosmetic results. The surgical procedure involves a double incision of the ribs parasternally and at the borderline of the funnel, the mobilised ventral part of the chest is elevated by a metal strut to an anatomically normal position. 235 patients have been operated on by this method. In 7% a local wound infection occured, there was one total recurrence and 15 partial recurrences. 4 years after operation 75% of the patients had an anatomically normal and well developed chest with an excellent cosmetic result.
Child↗
Instrumentation surgery for funnel chest.
Thirty four patients with funnel chest were operated on using the Zimmer plate and/or U shaped rod. There were no recurrences of the chest deformity and 78.6% were satisfied with the result. The low % VC significantly improved after the operation. Five cases had one of the following complications, massive bleeding from the internal thoracic artery, partial skin necrosis, rotational dislodgement of the rod, temporal subcutaneous infection or partial rupture of the pectoral muscle incision. The blood loss ensuing in one operation during the last 8 years has been less than 300 ml and the postoperative bed rest was less than 7 days. All the patients could get back to the preoperative daily activities within three weeks without wearing brace or chest protector. Therefore, our method is considered to be less invasive and very useful for correction of the funnel chest deformity.
Adolescent↗
[Early diagnosis of progression of funnel chest in children].
104 patients with progressive forms of funnel chest deformity of the II-III degree with Ehlers-Danlos-Marfan syndrome, Marfan-like phenotype, isolated funnel chest deformity and unclassified funnel chest deformity of the first degree were subjected to synromologic examination. There were detected 10 dysplastic signs, indicating funnel chest deformity progression: anti-Mongol shape of the eyes, arachnodactyly, high palate, Ehlers-Danlos syndrome, floor of the auricle's dysplasia, dolichostenomely, posture disturbance, mitral valve prolapse, umbilical hernia, wide filter. The results of biochemical examination of collagen metabolite--hydroxyproline++ (the first and the second hydroxyproline++ fraction ratio disturbance, decrease of the first hydroxyproline++ fraction percentage, disturbance of direct correlation between total hydroxyproline++ and percentage of the first hydroxyproline++ fraction)--corroborated the clinical data.
Adolescent↗
[Effect of subtotal resection of costal cartilage on the basic chest dimensions in children with funnel chest deformity].
The paper summarizes the results of anthropometric and computed tomographic studies of the external and internal chest dimensions in 86 patients with Degree II-III infundibuliform chest deformity. Full resection of deformed cartilages of the third to seventh ribs has been examined for its impact. The children with infundibuliform chest deformity have been found to have an impressed anteroposterior dimension of the bilateral chest. The transversal and anteroposterior dimensions of the chest remain unchanged after removal of cartilages. The chest enlarges only sagittaly. One- and three-year follow-ups have indicated that full removal of the deformed cartilage has no impact on the growth of the chest.
Adolescent↗
Unusual combination of pulmonary sequestration and funnel chest.
Cases of pulmonary sequestration and cases of funnel chest are frequently accompanied by other anomalies, although the combination of pulmonary sequestration and funnel chest is rare. In this study, we report ten cases of pulmonary sequestration, nine of which had the combination of pulmonary sequestration and other anomalies; four evidenced the unusual combination of pulmonary sequestration and funnel chest.
Abnormalities, Multiple↗
[Funnel chest and pigeon breast (author's transl)].
The dominant heredity of funnel chest formation is considered proved. The incidence of funnel chest is about 0.05% of the population, with the emphasis on boys. In very many cases deformities of the anterior chest wall are associated with other deformities. All patients with pigeon breast or funnel chest suffer considerably psychically under their deformity. This is the main indication for operation. The best age for operation is from the 2nd to 6th years of life. Conservative methods of treatment are never successful. Of the present day operative techniques, the stabilizing--by implantation of metal clips--are opposed to the nonstabilizing operative procedures. Both achieve equally good and completely satisfactory results in 85% of cases.
Abnormalities, Multiple↗
[Treatment of funnel chest with RTV-silicone implants].
The funnel chest is no physiological but a psychological problem for the majority of patients. Only 5% suffer from pathological parameters which require a surgical elevation of the funnel. After these rather complicated operations, however, only 60-80% are followed by good long-term results. The described RTV-silicone implant is formed preoperatively directly in the funnel and appears to be a simple safe and lasting alternative for most patients with a funnel chest.
Adolescent↗
[Indications for the surgical treatment of the funnel chest].
AIM OF THE STUDY: to establish the indications for surgical treatment of the funnel chest. PATIENTS AND METHODS: There was a retrospective and prospective analysis performed of the methods of investigation and treatment of 504 patients operated for the funnel chest during the period of 35 years (1968-2002). In order to make a right diagnosis and to establish the indications for surgical treatment a standard algorithm of investigations was prepared: examination, collecting the detailed life history, establishing a type and a degree of deformation, chest and column radiological examination, ECG, spirography and heart ultrasound examination. RESULTS: On basis of physical examination and anamnestic data the most clinical signs and complaints were established. The heart compression was found in preoperative X-rays in 476 (94.4%) patients, the heart was rotated and dislocated in 441 (87.5%) patients. Postoperatively 96.1% of patients were free of the heart compression symptoms and for 71.8% the heart rotation has disappeared. The pathological ECG findings were recorded for 382 (71.8%) patients and abnormal spirograms were taken for 31 (8.5%) patients. CONCLUSIONS: The following indications for the funnel chest surgical treatment were established: - obvious funnel chest diagnozed by physical examination, - complaints and disturbances clear from anamnestic data, - heart rotation and compression established by radiological examination, - pathological findings in cardiorespiratory system (ECG, echocardiography, and spirography). An optimal age for operation was found out to be between 3 and 7 years.
Age Factors↗
[Urinary excretion of hydroxyproline in funnel chest deformity].
Excretion of hydroxyproline with urine was studied in 16 children with localized form of funnel chest deformation simultaneously with Marfan and Ehlers-Danlos syndromes, in 9 children with the localized form of deformation within 6-8 months after thorax surgical plastic operation as well as in 3 children with Ehlers-Danlos syndrome but without funnel chest deformation. Funnel chest deformation of the II-III degree, independently of its form, was accompanied by a decrease of total hydroxyproline in urine as compared with healthy children of the similar age. The hydroxyproline excretion was normalized after thoracoplastic operation in the children with localized form of the chest deformation. In Ehlers-Danlos syndrome, independently on presence or absence of the chest deformation, relative content of free hydroxyproline was increased in urine, while the peptide-bound amino acid was decreased (peptides with molecular mass above 700 daltons); this phenomenon appears to be a characteristic property of the syndrome.
Adolescent↗
[Modified Ravitch operation in the treatment of patients with funnel chest].
The characteristic traits of funnel chest have been presented and the clinical results of surgical treatment in 13 patients by the modified Ravitch method have been discussed. Nine results were excellent and four results were good. A marked improvement of general physical function of the patients due to the increase of respiratory system efficiency and a good cosmetic effect were found. The modification of the operation consists in additional longitudinal osteotomy of the sternum, suturing of the manubrium to the sternum shaft, non-suturing of the rib cartilages after resection, filling of the through-like groove in the reposited sternum with the fragments of the resected rib cartilages, and immobilization of the fragments of the longitudinally osteotomized sternum that are inserted crosswise with several (usually three) Kirschner wires, based on the thorax.
Adolescent↗
Funnel chest. Psychological and psychosomatic aspects in children, youngsters, and young adults.
BACKGROUND: When considering the indications for operative correction of funnel chest, the first question is what is medically actually necessary, and what is founded simply on 'doctors opinion'. Furthermore symptoms are often only indirectly correlated with the basic illness. This paper suggests a possible way of objectivating the symptoms in 56 patients with funnel chest. METHODS: According to the results of our retrospective examinations the differentiation between 'physical' and (merely) 'cosmetic' findings in the definition of indications for operation of funnel chests in children, youngsters and young adults, should be dispensed with. The symptoms of "funnel chest" can be of varied significance, according to the degree of deformity, ranging from cosmetic fault to a severe handicap. Definition of indication thus depends in each case on all-inclusive plus differential plus interlocking-systemic diagnosis. In the course of this, not only somatic data, but also psychosocial characteristics can be objectivated and quantified. RESULTS: The results of our examinations show that the handicaps of a funnel chest influence all areas of life. Older children (over 11 years) display as a whole more psychological disorders. Along with specific embarassment reactions, social anxiety, feelings of stigma, limited capacity for work, orientation towards failure, reduced tolerance of frustration and temptation, limited capacity for communication and even markedly depressive reactions are observed. CONCLUSIONS: The underlying deformity and the psychological reactions to it make a long-term psychotherapy necessary. This may be laid out methodically more simply and takes less time, when a permanent correction is brought about at operation.
Adolescent↗