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At least 19 recordsLinked to original sources

PubMedDate not supplied

Surgical repair of pectus carinatum.

Pectus carinatum represents a variety of protrusion deformities of the anterior chest wall. Although various non-operative methods of treatment have been employed, surgery has been widely accepted as the only effective method for the correction of pectus carinatum. We evaluate our 14 year single center experience of pectus carinatum correction on 111 patients using a uniform technique of internal stabilization employing stainless steel struts. Operative correction required double bilateral chondrotomy parasternally and at points of transition to normal ribs, followed by detorsion of the sternum, retrosternal mobilization and correction of the everted sternum as well as of the everted and inverted ribs. The mobilized sternum after incomplete wedge osteotomy was finally stabilized by one transternal and two bilateral parasternal metal struts. The corrections were completed with successful repair in 109 patients (98.2%). Major recurrences in 2 patients (1.8%) were corrected while mild recurrence were observed in 3 patients (2.7%).

Adolescent↗

PubMed1987

Surgical correction of pectus carinatum.

Pectus carinatum is an infrequent but eminently correctable chest wall deformity. It is encountered much less frequently than pectus excavatum. In 12 years, from 1973 to 1985, 152 pectus carinatum (16.7%) and 758 pectus excavatum deformities (83.3%) were corrected. It occurs more frequently in boys (119 patients) than girls (33 patients). The majority, 89 cases, were symmetric, while 49 were asymmetric, and 14 were mixed deformities (ipsilateral carinatum, contralateral excavatum). In almost half the patients the deformity was not identified until after the 11th birthday. A family history of chest wall deformities was present in 26%, and of scoliosis in 12%. Associated musculoskeletal abnormalities were identified in 34 patients (scoliosis 23, Poland's syndrome 4, neurofibromatosis 2, Morquio's disease 2, vertebral anomalies 1, hyperlordosis 1, and kyphosis 1). Surgical correction required bilateral resection of the third through seventh costal cartilages in 143 patients, and unilateral resection in nine patients with an isolated abnormality. A single osteotomy was used in 88 patients and a double osteotomy in 53 patients. In 11 cases no osteotomy was required. Mixed deformity with posterior angulation of the sternum was managed by osteotomy and anterior displacement. The remaining cases had sternal osteotomy and fracture of the posterior cortex to correct anterior angulation. The operation was completed with a low complication rate 3.9% (pneumothorax 4, wound infection 1, atelectasis 1, and local tissue necrosis 1). Three patients required revision with additional unilateral lower cartilage resection for persistent malformation of the costal arch. All patients ultimately had a satisfactory result.

Adolescent↗

PubMed2000

Surgical treatment of pectus carinatum.

Pectus carinatum, just like its sister deformity pectus excavatum, is a condition with an undefined developmental mechanism and debated surgical techniques. Elongation of the costal cartilages and elongation and anterior displacement of the sternum characterize the different varieties of pectus carinatum. Repair of the anomaly involves positional correction as well as the shortening of the sternum and the maintenance of its corrected position by action of the rectus abdominis and pectoralis muscles.

Humans↗

PubMed2004

Chest wall anomalies: pectus excavatum and pectus carinatum.

Pectus excavatum, the concave depression of the breast bone, comprises most chest wall anomalies. The Nuss procedure, a minimally invasive procedure to correct pectus excavatum, has revolutionized the management of this disease over the past decade. The results and complications of this procedure are discussed. The surgical management of the less common pectus carinatum or "pigeon breast" also is reviewed.

Adolescent↗

PubMed1981

Pectus carinatum and pectus excavatum: are they the same disease?

Eighty cases of anterior chest wall deformities were reviewed. The group consisted of 47 patients with pectus carinatum and 33 patients with pectus excavatum. This 1.4:1 distribution has not been reported in the literature, where a 1:10 distribution is regularly cited. Important bronchopulmonary changes were found by chest x-rays in both groups. Formerly, alterations in pectus excavatum were attributed to the mechanical effect of the depressed sternum. The presence of the same symptoms and bronchopulmonary radiographic changes in patients with pectus carinatum suggests a primary pulmonary defect in both entities. However, bronchopulmonary changes were more prominent in patients with pectus excavatum than in patients with carinatum, which suggests that mechanical compression enhances the problem. Postoperative radiologic improvement was similar in both groups. The patients underwent a surgical procedure that included a sternal osteotomy and a complete removal of the costal cartilages. All patients survived. There were two recurrences. Considerable postoperative overgrowth of the unresected second costal cartilages was observed, hence our recommendation for routine removal of these structures. The habitus of prominent abdomen and stooped shoulders was not modified by the operation, but important symptomatic improvement and some radiologic improvement were observed in both groups.

Adolescent↗

PubMed2001

Surgical management of pectus carinatum: 30 years' experience.

Pectus carinatum is an uncommon malformation that is often more symptomatic than the appearance suggests, and one that physicians often do not refer for surgical correction. Hospital records of 90 patients who underwent repair of pectus carinatum deformities between 1970 and 2000 were reviewed. During the same period another 445 patients underwent repair of excavatum deformities. Minimal deformity was observed before the age of 10 years for 81 of 90 patients; only 7 of the 90 underwent repair before age 11 years. All patients were symptomatic; 84 had exertional dyspnea and exercise limitation, 52 had frequent respiratory infections, 24 had asthma, and 38 had chest discomfort. The mean pectus severity score (width of chest divided by the distance between the sternum and spine) was 1.73 (the normal chest is 2.56). The type of repair varied with the type of deformity, consisting of subperiosteal resection of the deformed cartilages, transverse osteotomy of the anterior sternum with insertion of a cartilage wedge, and support with a steel strut for 4 to 6 months in 76 of 90. There were no deaths within 1 year after the repair. Complications included hypertrophic scar (n = 13), wound seroma (n = 5), pleural effusion (n = 3), and pneumothorax (n = 2). The mean blood loss was 78 ml, and the mean hospital stay was 2.6 days. With a mean follow-up of 12.8 years, all patients experienced alleviation of respiratory symptoms and chest discomfort and diminished exercise limitation; 88 of 90 patients experienced a very good to excellent long-term result. One patient required reoperation. Pectus carinatum often causes more severe respiratory symptoms and exercise limitation than is generally recognized. Repair in 90 patients with carinatum deformities has resulted in marked clinical improvement in all patients, with low morbidity and short hospitalization.

Adolescent↗

PubMed1990

[Clinical function of the myocardium and cardio- and hemodynamics in patients with pectus carinatum deformity].

Seventy patients with pectus carinatum were examined. All the patients demonstrated the minimal signs of connective tissue deficiency. The ECG readings showed incomplete blockade of the bundle of His, ventricular extrasystole, WPW and CLC syndromes, and metabolic alterations in the myocardium. Mitral valve prolapse was discovered in 97% of cases by echocardiography. There was a decrease in myocardial contractility along with changes in cardio- and hemodynamics, which were more marked in patients having the corporocostal type of pectus carinatum. The correlation of these values with chest deformity was revealed.

Abnormalities, Multiple↗

PubMedDate not supplied

Scoliosis in children with pectus excavatum and pectus carinatum.

Between 1974 and 1985, 461 patients with pectus excavatum and 135 patients with pectus carinatum underwent operative repair of their anterior chest wall deformities. Twenty-one percent of patients with anterior chest wall deformity had mild scoliosis by clinical and radiographic examination. The average lateral spinal deformity was 15 degrees (range 6-78 degrees) for pectus excavatum patients and 16 degrees (range 5-57 degrees) for pectus carinatum patients. Eighteen percent of the pectus excavatum patients with scoliosis and 14% of the pectus carinatum patients with scoliosis required therapeutic intervention of bracing and/or arthrodesis.

Adolescent↗

PubMed2005

[The outcome of modified procedure for pectus carinatum correction].

OBJECTIVE: To improve the surgical procedure to correct pectus carinatum. METHODS: From 1990 to 2003, 9 patients with pectus carinatum were treated, whose ages ranged from 3 years and 6 months to 16 years. The conventional operation was performed on 4 patients, the modified procedure on 5 patients. The modified procedure included: (1) the shortening rib periosteum was not sutured transversally; (2) the corrected position of the sternum was stabilized with the metal strut. RESULTS: In 4 patients corrected by the conventional procedure, the sternum depression as pectus excavatum occurred in 1 case five years postoperatively. The results were satisfactory in 5 patients corrected by the modified procedure. The reconstructed thorax was symmetrical, without bulging or dimpling of sternum and costal cartilage. CONCLUSION: The improvement of operative method is reasonable and effective in correcting pectus carinatum.

Adolescent↗

PubMed2006

The Calgary protocol for bracing of pectus carinatum: a preliminary report.

BACKGROUND: The optimal treatment of pectus carinatum (PC) deformities is unclear. We propose a nonoperative approach using a lightweight, patient-controlled dynamic chest-bracing device. MATERIAL AND METHODS: With ethical approval, 24 patients with PC were treated at the Alberta Children's Hospital between January 1998 and April 2005. There were 6 (25%) females and 18 (75%) males, with a mean age of 12.9 years at the onset of treatment. Treatment involved fitting of a lightweight, patient-controlled chest brace, worn for 23 hours per day (correction phase [CP]) until the convex deformity was corrected. Following correction of the deformity, bracing was reduced to 8 hours per day (maintenance phase) until axial skeletal maturation ceased. Monitoring was done by measurement of the external pectus carinatum protrusion as well as subjective patient and surgeon appraisal of appearance and exercise tolerance. RESULTS: Nineteen (79.2%) patients have completed initial treatment (mean CP time, 4.3 +/- 2.1 months). There were 3 patients (12.5%) who were noncompliant, and 2 (8.3%) are still in the initial CP phase of therapy. Fourteen (58.3%) patients are presently in maintenance phase, nocturnally braced, and 2 (8.3%) have completed therapy. In patients completing initial treatment, the protrusion pectus carinatum protrusion (pre 22 +/- 6 vs post 6.0 +/- 6.2) and subjective appearance (change + 1.8+/-0.4) showed a significant improvement (P < .001 for both) with no change in exercise tolerance. CONCLUSION: Compressive bracing results in a significant subjective and objective improvement in PC appearance in skeletally immature patients. However, patient compliance and diligent follow up appear to be paramount for the success of this method of treatment. Further studies are required to show the durability of this method of treatment.

Adolescent↗

PubMed2005

[A minimally invasive technique to repair pectus carinatum. Preliminary report].

The present report deals with a new technique for the correction of pectus carinatum. Although less frequent than pectus excavatum, this deformity leads to numerous consultations, as it is difficult to conceal and affects the personality and behavior of many young patients. We report the case of a 13-year-old boy with asymmetrical pectus carinatum. The chest wall was compressible, so the protrusion was corrected by means of intrathoracic compression. In this technique, the sternochondral region is compressed by implanting a metal bar in the presternal region and securing it bilaterally to the posterolateral portion of the costal arches. The strut remains implanted until remolding of the chest contour is achieved. In this case, the strut was removed after 1 year and the new chest contour has been maintained unchanged more than 8 months following surgery. In conclusion, this minimally invasive technique for the treatment of pectus carinatum by means of intrathoracic compression appears to be a valid alternative to more invasive techniques and should be considered in appropriate cases.

Adolescent↗

PubMed2006

Nonoperative correction of pectus carinatum with orthotic bracing.

BACKGROUND: This study sought to evaluate the efficacy of nonoperative compression in correcting pectus carinatum in children. MATERIALS AND METHODS: Children presenting with pectus carinatum between August 1999 and January 2004 were prospectively enrolled in this study. The management protocol included custom compressive bracing, strengthening exercises, and frequent clinical follow-up. RESULTS: There were 30 children seen for evaluation. Their mean age was 13 years (range, 3-16 years) and there were 26 boys and 4 girls. Of the 30 original patients, 6 never returned to obtain the brace, leaving 24 patients in the study. Another 4 subjects were lost to follow-up. For the remaining 20 patients who have either completed treatment or continue in the study, the mean duration of bracing was 16 months, involving an average of 3 follow-up visits and 2 brace adjustments. Five of these patients had little or no improvement due to either too short a follow-up or noncompliance with the bracing. The other 15 patients (75%) had a significant to complete correction. There were no complications encountered during the study period. CONCLUSION: Compressive orthotic bracing is a safe and effective alternative to both invasive surgical correction and no treatment for pectus carinatum in children. Compliance is critical to the success of this management strategy.

Adolescent↗

PubMed2000

Compressive orthotics in the treatment of asymmetric pectus carinatum: a preliminary report with an objective radiographic marker.

BACKGROUND/PURPOSE: Pectus carinatum (PC) traditionally has been managed with surgical reconstruction. Compressive orthosis also has resulted in subjective improvement in this defect. The goal of the authors was to develop an alternative brace and an objective radiographic marker to monitor the effects of chest wall compression on sternal protrusion. METHODS: Baseline chest computed tomography (CT) scans were obtained for 5 teenage boys with chondrogladiolar type of PC. The angle at the point of greatest sternal rotation was measured as the baseline deformity. Compressive orthosis was initiated using a custom-fitted brace. Follow-up chest CT scans were obtained to document change in sternal rotation. RESULTS: One patient was lost to follow-up after 6 months with subjective improvement. Another opted for surgical correction after 3 months, having shown a 16% decrease in sternal rotation preoperatively. Two patients showed subjective improvement corroborated by 33% and 44% decreases in sternal rotation. The fifth patient, who discontinued bracing after 1 month, showed a 25% increase 6 months later. CONCLUSIONS: Preliminary results indicate a potential role for compressive orthosis in the management of pectus carinatum. The objective radiographic marker described may be used to monitor the effects of growth or treatment with compressive orthosis.

Adolescent↗

PubMed2006

New endoscopic minimal access pectus carinatum repair using subpectoral carbon dioxide.

PURPOSE: This study establishes a minimal access hybrid technique for pectus carinatum repair. Based on 132 conventional repairs (1984-2000) and our own endoscopic technique for correcting prominent costal arches, the conventional carinatum repair was adapted to an endoscopic-assisted technique. DESCRIPTION: Inserting two submuscular trocars and inflating CO2, the entire ventral thoracic wall was dissected endoscopically detaching pectoral muscles from ribs and sternum. February 2001 to February 2004, we repaired 37 patients (32 male) of 16.8 +/- 4.3 years (12 to 36 years). Endoscopic-assisted rib resection and axial reanastomosis, transsternal struts, and sternotomies were performed semi-open from a 2.9 to 4.7 cm incision. EVALUATION: All were completed minimally invasively, one seroma was managed conservatively. Thirty-three patients rated their result as excellent, 4 as good with a follow-up of 29.1 +/- 9.5 months (range, 18 to 55 months). Twenty-one struts were removed with no recurrence. CONCLUSIONS: Minimal access pectus carinatum repair is safe, effective, and offers high comfort for the patient. The results are at least as good as conventional repairs, but hospital stays could be halved. Encouraging results of this early experience warrant further evaluation by other centers.

Adolescent↗

PubMed1979

Pectus carinatum.

In the mirror of the pertinent literature, we present our experiences gained in 161 operations for pectus carinatum. The Type I (keel chest) deformity is corrected by bilateral resection of the costal cartilages, transverse osteotomy of the sternum, detachment of the xiphoid process, and resection of the lower end of the body of the sternum. The sternum is maintained in its corrected position by utilizing the pulling force of the rectus muscles through the reattached xiphoid and by tacking the pectoralis muscles together in front of the breast bone. Type II (pouter pigeon breast) is handled by double transverse osteotomy, chiseling off the protuberant portion of the strernomanuberial junction, and by supporting the lower sternal body with either the suspended xiphoid process or with Marlex mesh. Limited forms of Type III (asymmetrical or lateral pectus carinatum) are managed with simple resection of the involved cartilages only. If the anomaly is more extensive, bilateral resection of the cartilages and correction of the sternal axis is carried out.

Adolescent↗

PubMed1979

Pectus carinatum: results of surgical therapy.

There are a variety of protrusion defects of the anterior chest which are collectively referred to as pectus carinatum. Over a 14-yr period, 13 patients have had surgical correction of pectus carinatum at The Johns Hopkins Hospital. Technique includes costal cartilage resection and a sternal osteotomy. There was no mortality, complications were few and results are good. Repair is recommended for patients in late adolescence due to the cosmetic nature of the procedure, the apparent lack of an associated postural deformity and the good results of operation in this age group.

Adolescent↗

PubMed1997

Correction of pectus excavatum and pectus carinatum assisted by the endoscope.

Six patients with pectus excavatum and two patients with pectus carinatum had their conditions corrected by a partial costal cartilage resection with a sternal osteotomy through a 2.5-cm to 4-cm skin incision located just above the xyphoid process assisted by an endoscope. In addition to the incision, stab wounds of less than 3 mm in diameter were also made, in some cases, for insertion of the surgical instruments to facilitate the operation. The ribs and rib cartilages were exposed beyond the affected area through a prexyphoid incision under endoscopic control. The mobility of the skin incision site was thus enhanced, and it was possible to perform most of the subperichondrial partial costal cartilage resection under direct visualization. The pleura was freed from the sternum under endoscopic visualization. The advantages of this technique include minimal operative scars and the ability to free the pleura from the sternum under endoscopically magnified visualization, which prevents rupturing of the pleura in the retrosternal area.

Adolescent↗

PubMed1993

Pectus carinatum successfully treated with bracing. A case report.

We report the case of a 14 year old girl who desired treatment for a cosmetically objectionable pectus carinatum deformity. She was initially managed with a corrective underarm body cast for six weeks followed by full-time bracing for seven months. Subsequently, she was braced only at night for another eight months. Seven years after the onset of treatment she had an excellent result without recurrence of deformity. In a well-motivated, skeletally immature individual bracing can be an effective treatment for cosmetically displeasing pectus carinatum.

Adolescent↗