Surgical correction of pectus carinatum: lessons learned from 260 patients

      Abstract

      Background

      Patients with pectus carinatum (PC) frequently experience physiologic symptoms, which are often overlooked by physicians. Sparse data have been published regarding the indications for correction of PC and the newer techniques of surgical repair.

      Methods

      Since 1970, 260 (89% males) symptomatic patients with PC with a mean severity index of 1.81 underwent open surgical correction at the University of California, Los Angeles, Medical Center by 1 surgeon. All patients had experienced dyspnea, reduced endurance, and tachypnea with exertion. Asthmatic symptoms were noted by 22%. The mean age at operation was 18.2 years. Asymmetric protrusion was present in 126 (48%) patients. Combined protrusion of the upper chest and depression of the lower chest was present in 17 patients. Varying degrees of depression on one or both sides of the lower chest was present in 36%. Repair of recurrent PC deformities was performed on 16 patients. Progressively, less costal cartilage was resected over the 37-year period, with the last 181 patients having only short segments excised from both ends of deformed cartilages with suture reattachment. Transverse sternal osteotomy was used on all, and 242 (93%) had a support strut anterior to the sternum for 6 months.

      Results

      Exercise induced dyspnea, and reduced endurance was improved in all patients within 3 to 6 months after repair. Need for repair of recurrent deformities and resection of mild residual cartilage protrusion was reduced more than 3-fold when less extensive cartilage resection with wire reattachment was used. Postoperative complications in the last 181 patients were minor and less frequent, pain was less severe, hospitalization was shorter (mean, 2.6 days), and postoperative results were better than when more extensive repairs were used in previous years. With a mean overall follow-up of 6.2 years, 97.4% of all patients reported a very good or excellent result.

      Conclusions

      In this largest reported series of PC repair, progressively less extensive open techniques have resulted in low morbidity, mild pain, short hospital stay, and very good physiologic and cosmetic results.

      Key words

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      References

        • Brodkin H.A.
        Pigeon breast congenital chondrosternal prominence: etiology and surgical treatment by xiphosternopexy.
        Arch Surg. 1958; 77: 261-268
        • Pena A.
        • Perez L.
        • Nurko S.
        • et al.
        Pectus carinatum and pectus excavatum: are they the same disease.
        Am Surg. 1981; 47: 215-218
        • Shamberger R.C.
        Congenital chest wall deformities.
        in: Grosfeld J.L. O'Neill Jr, J.A. Coran A.G. Pediatric Surgery. 6th Edition. Mosby Inc, Philadelphia, PA2006: 904
        • Fonkalsrud E.W.
        • Anselmo D.M.
        Less extensive techniques for repair of pectus carinatum: the undertreated chest deformity.
        J Am Coll Surg. 2004; 198: 898-905
        • Fonkalsrud E.W.
        • Beanes S.
        Management of pectus carinatum: 30 years experience.
        World J Surg. 2001; 25: 898-903
        • Haller Jr, J.A.
        • Kramer S.S.
        • Lietman S.A.
        Use of CT scans in selection of patient's for pectus excavatum surgery: a preliminary report.
        J Pediatr Surg. 1987; 22: 904-906
        • Picard L.K.
        • Tepas J.J.
        • Shermeta D.W.
        • et al.
        Pectus carinatum: results of surgical therapy.
        J Pediatr Surg. 1979; 14: 228-230
        • Jaroszewski D.
        • Fonkalsrud E.W.
        Repair of pectus chest deformities in 320 adult patients: 21 year experience.
        Ann Thorac Surg. 2007; 84: 429-433
        • 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; 35: 1183-1186
        • Frey A.S.
        • Garcia V.F.
        • Brown R.L.
        • et al.
        Nonoperative management of pectus carinatum.
        J Pediatr Surg. 2006; 41: 40-45
        • 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
        • Shamberger R.C.
        • Welch K.J.
        Surgical correction of pectus carinatum.
        J Ped Surg. 1987; 22: 48-53
        • Shamberger R.C.
        Congenital chest wall deformities.
        Current Prob Surg. 1996; 33: 469-552
        • Currarino G.
        • Silverman F.N.
        Premature obliteration of sternal sutures in pigeon-breast deformity.
        Radiology. 1958; 70: 532-540
        • Shamberger R.C.
        • Welch K.J.
        Surgical correction of chondromanubrial deformity (Currarino-Silverman syndrome).
        J Pediatr Surg. 1988; 23: 319-322
        • Fonkalsrud E.W.
        • Mendoza J.
        Open repair of pectus excavatum and carinatum deformities with minimal cartilage resection.
        Am J Surg. 2006; 191: 779-784
        • Ravitch M.M.
        The operative correction of pectus carinatum (pigeon breast).
        Ann Surg. 1960; 151: 705-714
        • Welch K.J.
        • Vos A.
        Surgical correction of pectus carinatum (pigeon breast).
        J Pediatr Surg. 1973; 8: 659-663
        • Adkins P.C.
        • Blades B.
        A stainless steel strut for correction of pectus excavatum.
        Sung Gynecol Obstet. 1961; 113: 111-113
        • Chang P.Y.
        • Lai J.L.
        • Chen J.C.
        • et al.
        Long-term changes in bone and cartilage after Ravitch's thoracoplasty: findings from multislice computed tomography with 3-dimensional reconstruction.
        J Pediatr Surg. 2006; 41: 1947-1950
      1. Martinez D, Juame J, Stein T, et al. The effect of costal cartilage resection on chest wall development. Pediatr Surg Int 119;5:170-173.