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11 - Chest wall deformities

from Part III - Thorax

Published online by Cambridge University Press:  08 January 2010

Donald Nuss
Affiliation:
Children's Hospital of the King's Daughters, Norfolk, VA, USA
Mark D. Stringer
Affiliation:
University of Otago, New Zealand
Keith T. Oldham
Affiliation:
Children's Hospital of Wisconsin
Pierre D. E. Mouriquand
Affiliation:
Debrousse Hospital, Lyon
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Summary

Chest wall deformities fall into two categories; those in which there is overgrowth of the ribs and cartilages causing either a depression (excavatum) or protrusion (carinatum) of the anterior chest wall, and those in which there is an absence (agenesis), deficiency (atresia), or failure of closure (dysplasia) of the various chest wall structures.

Pectus excavatum is by far the most common chest wall anomaly and occurs with a frequency of 1 in 1000 individuals (Fig. 11.1). Pectus carinatum is much less common, with about 10 pectus excavatum cases for each pectus carinatum in a large series, and usually presents during the pubertal growth spurt (Fig. 11.2).

The abnormalities in which there is partial agenesis or failure of fusion (ectopia cordis, Cantrell's pentalogy) are fortunately very rare because many of these conditions are incompatible with life (Fig. 11.3).

In Poland's syndrome, there is variable absence of breast tissue, pectoralis major muscle, pectoralis minor muscle, and ribs. Some patients lack only one structure and others lack all of them and have only skin covering the thoracic cavity (Fig. 11.4).

Pectus excavatum

Pathophysiology and symptoms

Anatomically, the depression of pectus excavatum may be mild, moderate, or severe, and it may be localized or diffuse, symmetric or asymmetric. Asymptomatic cases may be treated with an exercise and posture program, whereas anatomically severe cases may be symptomatic and require surgical correction.

Type
Chapter
Information
Pediatric Surgery and Urology
Long-Term Outcomes
, pp. 135 - 149
Publisher: Cambridge University Press
Print publication year: 2006

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References

Williams, A. M. & Crabbe, D. C. G.Pectus deformities of the anterior chest wall. Paediatr. Resp. Rev. 2003; 4(3):237–242.CrossRefGoogle ScholarPubMed
Molik, K. A., Engum, S. A., Rescorla, F. J.et al. Pectus excavatum repair: Experience with standard and minimally invasive techniques. J. Pediatr. Surg. 2001; 36(2):324–328.CrossRefGoogle Scholar
Shamberger, R. C. Congenital chest wall deformities. In Pediatric Surgery. 5th edn. Philadelphia, PA: Elsevier, 1998: 787–817.Google Scholar
Coulson, W.Deformities of the chest. Lond. Med. Gaz. 1820; 4:69–73.Google Scholar
Sauerbruch, F.Operative Beseitigung der Angeborenen Trichterbrust. Deutsche Zeitschr. f. Chir. 1931; 234:760.CrossRefGoogle Scholar
Ravitch, M. M.The operative treatment of pectus excavatum. Ann. Surg. 1949; 129:429–444.CrossRefGoogle ScholarPubMed
Wallgren, G. R. & Sulamaa, M.Surgical treatment of funnel chest. Exhib. VIII, Int. Congr. Paediatr. 1949: 32.Google Scholar
Adkins, P. C., & Blades, B. A.Stainless steel strut for correction of pectus excavatum. Surg. Gynecol. Obstet. 1961:111–113.Google Scholar
Welch, K. J.Satisfactory surgical correction of pectus excavatum deformity in childhood. J. Thorac. Surg. 1958; 36:697–713.Google ScholarPubMed
Martinez, D., Juame, J., Stein, T., & Pena, A.The effect of costal cartilage resection on chest wall development. Pediatr. Surg. Int. 1990; 5:170–173.CrossRefGoogle Scholar
Haller, J. A., Colombani, P. M., Humphries, C. T.et al. Chest wall constriction after too extensive and too early operations for pectus excavatum. Ann. Thorac. Surg. 1996; 61:1618–1625.CrossRefGoogle ScholarPubMed
Nuss, D., Kelly, R. E. Jr., Croitoru, D. P., & Katz, M. E.A 10-year review of a minimally invasive technique for the correction of pectus excavatum. J. Pediatr. Surg. 1998; 33(4):545–552.CrossRefGoogle ScholarPubMed
Nuss, D., Kelly, R. E. Jr., Croitoru, D. P., & Swoveland, B.Repair of pectus excavatum. Pediatr. Endosurg. Innovat. Techn. 1998; 2:205–221.CrossRefGoogle Scholar
Croitoru, D. P., Kelly, R. E. Jr., Goretsky, M. J.et al. Experience and modification update for the minimally invasive Nuss technique for pectus excavatum repair in 303 patients. J. Pediatr. Surg. 2002; 37(3):437–445.CrossRefGoogle ScholarPubMed
Malek, M. H., Fonkalsrud, E. W., & Cooper, C. B.Ventilatory and cardiovascular responses to exercise in patients with pectus excavatum. Chest 2003; 124(3):870–882.CrossRefGoogle ScholarPubMed
Malek, M. H. & Fonkalsrud, E. W.Cardiorespiratory outcome after corrective surgery for pectus excavatum: a case study. Med. Sci. Sports Exerc. 2004; 36(2):183–190.CrossRefGoogle ScholarPubMed
Borgeskov, S. & Raahave, D.Long-term result after operative repair of funnel chest. Thorax 1971; 26:74–76.CrossRefGoogle Scholar
Morshuis, W., Folgering, H., Barentsz, J.et al. Pulmonary function before surgery for pectus excavatum and at long-term follow-up. Chest 1994; 105:1646–1652.CrossRefGoogle ScholarPubMed
Quigley, P. M., Haller, J. A., Jelus, K. L.et al. Cardiorespiratory function before and after corrective surgery in pectus excavatum. J. Pediatr. 1996; 128:638–643.CrossRefGoogle ScholarPubMed
Lawson, M. L., Cash, T. F., Akers, R.et al. A pilot study of the impact of surgical repair on disease-specific quality of life among patients with pectus excavatum. J. Pediatr. Surg. 2003; 38(6):916–918.CrossRefGoogle ScholarPubMed
Shamberger, R. C. & Welch, K. J.Surgical correction of pectus carinatum. J. Pediatr. Surg. 1987; 22:48–53.CrossRefGoogle ScholarPubMed
Chin, E. F.Surgery of funnel chest and congenital sternal prominence. Br. J. Surg. 1957; 44:360–376.CrossRefGoogle ScholarPubMed
Robisek, F., Cook, J. W., Daugherty, H. K.et al. Pectus carinatum. J. Thorac. Cardiovasc. Surg. 1979; 78:52–61.Google Scholar
Pena, A., Perez, L., Nurka, S., et al. Pectus carinatum and pectus excavatum: are they the same disease?Am. Surg. 1981; 47:215–218.Google ScholarPubMed
Haje, S. A. & Bowen, J. R.Preliminary results of orthotic treatment of pectus deformities in children and adolescents. J. Pediatr. Orthop. 1992; 12:795–800.CrossRefGoogle ScholarPubMed
Currarino, G. & Silverman, F. N.Premature obliteration of the sternal sutures and pigeon-breast deformity. Radiology 1958; 70:532–540.CrossRefGoogle ScholarPubMed
Egan, J. C., DuBois, J. J., Morphy, M.et al. Compressive orthotics in the treatment of asymmetric pectus carinatum: a preliminary report with an objective radiographic marker. J. Pediatr. Surg. 2000; 8:1183–1186.CrossRefGoogle Scholar
Ravitch, M. M.The operative correction of pectus carinatum (pigeon breast). Ann. Surg. 1960; 151:705–714.CrossRefGoogle Scholar
Welch, K. J. & Vos, A.Surgical correction of pectus carinatum (pigeon breast). J. Pediatr. Surg. 1973; 8:659–667.CrossRefGoogle Scholar
Shamberger, R. C.Congenital chest wall deformities. Curr. Probl. Surg. 1996; 33(6):469–542.CrossRefGoogle ScholarPubMed
Freire-Maia, N., Chautard, E. A., & Opitz, J. M.The Poland Syndrome-clinical and genealogical data, dermatoglyphic analysis, and incidence. Hum. Hered. 1973; 23:97–104.CrossRefGoogle ScholarPubMed
Poland, A.Deficiency of the pectoralis muscles. Guys. Hosp. Rep. 1841; 6:191–193.Google Scholar
Lallemand, L. M.Ephermerides Medicales de Montpellier 1826; 1:144–147.Google Scholar
Froriep, R.Beobachtung eines Falles Von Mangel der Brustdrauuse 1839; 10:9–14.Google Scholar
Golladay, E. S. Pectus carinatum and other deformities of the chest wall. In Zeigler, M. M., Azizkhan, R. G., & Weber, T. R., eds. Operative Pediatric Surgery. New York: McGraw-Hill, 2003: 269–278.Google Scholar
Shamberger, R. C., Welch, K. J., & Upton, J., III. Surgical treatment of thoracic deformity in Poland's Syndrome. J. Pediatr. Surg. 1989; 24:760–766.CrossRefGoogle ScholarPubMed
Seyfer, A. E., Icochea, R., & Graber, G. M.Poland's anomaly: natural history and long-term results of chest wall reconstruction in 33 patients. Ann. Surg. 1988; 208:776–782.CrossRefGoogle ScholarPubMed
Samarrai, A. R., Charmockley, H. A., & Attr, A. A.Complete cleft sternum: classification and surgical repair. Int. Surg. 1985; 70:71–73.Google ScholarPubMed
Knox, L., Tuggle, D., & Knott-Craig, C. J.Repair of congenital sternal clefts in adolescence and infancy. J. Pediatr. Surg. 1994; 29:1513–1516.CrossRefGoogle ScholarPubMed
Shamberger, R. C. & Welch, K. J.Sternal defects. Pediatr. Surg. Int. 1990; 5:156–164.CrossRefGoogle Scholar
Amato, J. J., Zelen, J., & Talwalker, N. G.Single-stage repair of thoracic ectopia cordis. Ann. Thorac. Surg. 1995; 59:518–520.CrossRefGoogle ScholarPubMed
Groner, J. I. Ectopia cordis and sternal defects. In Zeigler, M. M., Azizkhan, R. G., & Weber, T. R., eds. Operative Pediatric Surgery. New York: McGraw-Hill, 2003: 279–293.Google Scholar
Campbell, R. M. & Smith, M.Treatment of thoracic insufficiency syndrome associated with congenital scoliosis. J. Bone. Joint. Surg. 1997; 79B(1):82.Google Scholar
Jeune, M., Carron, R., Beraud, C.et al. Polychondrodystrophie avec blocage thoracique d'evolution fatale. Pediatrics 1954:390–392.Google Scholar
Borland, L. M.Anesthesia for children with Jeune's Syndrome (asphyxiating thoracic dystrophy). Anesthesiology 1987; 66:86–88.CrossRefGoogle Scholar
Tahernia, A. C. & Stamps, P.Jeune's Syndrome (asphyxiating thoracic dystrophy). Chin. Pediatr. 1977; 16:903–907.Google Scholar
Williams, A. J., Vawter, G., & Reid, L. M.Lung structure in asphyxiating thoracic dystrophy. Arch. Pathol. Lab. Med. 1984; 108:658–661.Google ScholarPubMed
Finegold, J., Katzew, H., Genieser, N. B.et al. Lung structure in thoracic dystrophy. Am. J. Dis. Child. 1971; 122:153–159.Google ScholarPubMed
Langer, L. O.Thoracic pelvic phalangeal dystrophy: asphyxiating thoracic dystrophy of the newborn, infantile thoracic dystrophy. Radiology 1968; 91:447–456.CrossRefGoogle Scholar
Oberklaid, F., Dnaks, D. M., Mayne, V.et al. Asphyxiating thoracic dysplasia. Arch. Dis. Child. 1977; 52:758–765.CrossRefGoogle ScholarPubMed
Campbell, R. M. The incidence of proximal cervical spine stenosis in Jeune's asphyxiating dystrophy, presented at The Scoliosis Research Society; 2001.
Herdman, R. C. & Langer, L. O.The thoracic asphyxiant dystrophy and renal disease. Am. J. Dis. Child. 1977; 52:192–201.Google Scholar
Jarcho, S. & Levin, P. M.Hereditary malformations of the vertebral bodies. Bull. Johns Hopkins Hosp. 1938; 62:216–226.Google Scholar
Roberts, A. P., Conner, A. N., Tolmie, J. L.et al. Spondylothoracic and spondylocostal dystosis: hereditary forms of spinal deformity. J. Bone Joint Surg. 1988; 70B:123–126.CrossRefGoogle Scholar
Heilbronner, D. M. & Renshaw, T. S.Spondylothoracic dysplasia. J. Bone Joint Surg. Am. 1984; 66:302–303.CrossRefGoogle ScholarPubMed
McMaster, M. J. Congenital scoliosis. In: Weinstein, S. L., ed. The Pediatric Spine: Principles and Practice. New York: Raven Press; 1994.Google Scholar
McMaster, M. J.Congenital scoliosis caused by unilateral failure of vertebral segmentation with contralateral hemivertibrae. Spine 1998; 23:998–1005.CrossRefGoogle Scholar
McMaster, M. J. & David, C.Hemivertebrae as a cause of scoliosis: a study of 104 patients. J. Bone Joint Surg. 1986; 68B:588–595.CrossRefGoogle Scholar
Campbell, R. M.Congenital scoliosis due to multiple vertebrae anomalies associated with thoracic insufficiency syndrome. Spine: State Art Rev. 2000; 14:209–218.Google Scholar
Campbell, R. M., Smith, M. D., Mayes, T.et al. The characteristics of thoracic insufficiency syndrome associated with fused ribs and congenital scoliosis. J. Bone Joint Surg. 2003; 85:399–408.CrossRefGoogle ScholarPubMed
Todd, D. W., Tinguely, S. T., & Norberg, W. J.A thoracic expansion technique for Jeune's asphyxiating thoracic dystrophy. J. Pediatr. Surg. 1986; 21:161–163.CrossRefGoogle ScholarPubMed
Barnes, N. D., Hall, D., Milner, A. D.et al. Chest reconstruction in asphyxiating thoracic dystrophy. Arch. Dis. Child. 1971; 46:833–837.CrossRefGoogle Scholar
Weber, T. R. & Kurkchubasche, A. G.Operative management of asphyxiating thoracic dystrophy after pectus repair. J. Pediatr. Surg. 1998; 33:262–265.CrossRefGoogle ScholarPubMed
Sharoni, E., Erez, E., Chorer, G.et al. Chest reconstruction in asphyxiating thoracic dystrophy. J. Pediatr. Surg. 1998; 33:1578–1581.CrossRefGoogle ScholarPubMed
Davis, J. T., Heistein, J. B., Castile, R. G.et al. Lateral thoracic expansion for Jeune's syndrome: mid-term results. Ann. Thorac. Surg. 2001; 72:872–878.CrossRefGoogle Scholar
Campbell, R. M., Hell-Vocke, A. K.Growth of the thoracic spine in congenital scoliosis after expansion thoracoplasty. J. Bone Joint Surg. 2003; 85A:409–419.CrossRefGoogle Scholar

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