OBJECTIVETo improve sternal elevation for pectus excavatum to be more simple, less injured and less recurrent.

METHODSWe modified procedures for the sternal elevation for pectus excavatum by dispersal of the shortened fibrous bundle connection with central tendon of the diaphragm, correction of the reverse angle of sternocostales joins, transverse cuneiform anterior osteotomy of sternum and reconnection of oblique resected costal cartilage.

RESULTSSince March 1997, 8 children (4 - 10-year-old) with the pectus excavatum have been treated by this modified sternal elevation, 4 of them who suffer from quick heart pulse improved their heart rate immediately during the operation, all patients have less bleeding and good cosmetic appearance without any complications. There were satisfactory results without recurrence after 6 months to 1 year follow-up.

CONCLUSIONThe modified sternal elevation for pectus excavatum is safe, effective and reliable method.

Child ; Child, Preschool ; Female ; Follow-Up Studies ; Funnel Chest ; surgery ; Humans ; Male ; Sternum ; surgery

Two sexually intact male Bengal cats, one a 4-month-old weighing 2.8 kg and the other, a 3-month-old weighing 2.0 kg, were presented to the University of Missouri-Columbia Veterinary Teaching Hospital for evaluation of respiratory distress. On initial presentation, both cats were dyspneic, exercise intolerant, and had marked concave deformation of the caudal sternum. Surgical correction of pectus excavatum was performed using a cylindrical external splint and U-shaped xternal splint. Post-operative thoracic radiography revealed that there was decreased concavity of the sternum and increased thoracic height at the level of the caudal sternebrae in both cats.
Animals ; Cat Diseases/*surgery ; Cats ; Funnel Chest/surgery/*veterinary ; Lung Diseases/etiology/veterinary ; Male ; Treatment Outcome

We at Keimyung University Dongsan Medical Center experienced simultaneous repair of pectus excavatum and secundum atrial septal defect. We used resection deformed perichondrium, raising sternum at right angle to secure good operative field for open heart surgery. Mechanical ventilation was applied which could be weaned on postoperative 2 hours. The hospital course was uneventful without any other sequale. The patient was discharged on postoperative day 6.
Funnel Chest* ; Heart Septal Defects, Atrial* ; Humans ; Respiration, Artificial ; Sternum ; Thoracic Surgery

Although the incidence of descending necrotizing mediastinitis(DNM) is low, this is a serious disease because it"s mortality have been reported to be as high as 40~50%. Currently, many authors have emphasized aggressive surgical approaches rather than medical treatment alone. We report good results in 2 DNM patients treated by less invasive approach with video-assisted thoracoscopic surgery. Less invasive methods with video-assisted thoracoscopic surgery can reduce hospital stay and morbidity if effective drainage can be achieved in selected DNM patients.
Drainage ; Funnel Chest ; Humans ; Incidence ; Length of Stay ; Marfan Syndrome ; Mediastinitis* ; Mortality ; Thoracic Surgery, Video-Assisted*

BACKGROUND: Nuss procedure used in pectus excavatum repair is preferred, because of its excellent effect from the cosmetic point of view and improved pulmonary function, but it cause severe pain due to thoracic expansion after the operation. This study was designed to evaluate effective fentanyl dose using an intravenous patient-controlled analgesia (IV-PCA) pump for pain control following pectus excavatum repair in pediatric patients. METHODS: Sixty patients undergoing elective thoracic surgery were randomly assigned to received fentanyl 0.5microgram/kg/hr (Group I, n = 20), 0.7microgram/kg/hr (Group II, n = 20), and 1.0microgram/kg/hr (Group III, n = 20) via an IV-PCA pump (basal, 1 ml/h; bolus, 0.5 ml; lock out interval, 30 min) after operation. A blind observer evaluated each patient using the Children's Hospital of Eastern Ontario pain scale (CHEOPS) and the faces scale (FS). Incidences of side effects and pain control satisfaction were assessed at postoperative 48 hrs. RESULTS: There were no significant differences in CHEOPS or FS score between the groups the postoperative 48 hrs period. CHEOPS and FS scores at 4 and 8 hrs in groups II and III were significantly lower than in group I (P<0.05), but all groups showed lower CHEOPS and FS scores during the first postoperative 48 hrs. Satisfaction of pain control assessment by mothers was significantly higher in groups II and III than in group I (P<0.05). CHEOPS and FS scores were highly correlated with each other (P<0.001). CONCLUSIONS: We conclude that infusion of fentanyl at 0.5microgram/kg/hr using an IV-PCA pump is effective for pain control of 5 years of age or older after Nuss procedure.
Analgesia, Patient-Controlled* ; Fentanyl* ; Funnel Chest* ; Humans ; Incidence ; Mothers ; Ontario ; Thoracic Surgery

Pectus excavatum is the common congenital chest wall deformity in children, and Nuss procedure is the conventional surgical treatment for this disease. Nuss procedure is superior to Ravitch correction for it is less harmful in terms of the surgical technique. However, Nuss procedure is associated with severe postoperative pain, thus adequate postoperative analgesia is important. In this review, factors that influence the postoperative pain after Nuss procedure, the pain managements, the related complications and the side effects of drugs are discussed.
Analgesia ; methods ; Child ; Child, Preschool ; Funnel Chest ; surgery ; Humans ; Pain, Postoperative ; etiology ; therapy

Echocardiography, Three-Dimensional ; Funnel Chest/surgery* ; Humans ; Ventricular Dysfunction, Right/diagnostic imaging* ; Ventricular Function, Right

The presense of pectus excavatum in Marfan's syndrome may complicate cardiac operation by making midline sternotomy technically more difficult and limiting the operative exposure of the heart. We operated on a 33 year old male patient with Marfan's syndrome and severe pectus excavatum who had severe mitral regurgitation and moderate aortic regurgitation with 52mm aortic root dilation. The operative field was adequately exposed through a midline sternal incision with two sternal retactors. The patient underwent Bentall operation and mitral valve replacement. The repair of pectus excavatum was performed after completion of CPB and the administration of protamin. Permanent internal stabilization achieved by overlapping of the ends of lower ribs and reinforced with sternal closure wire.
Adult ; Aortic Valve Insufficiency ; Funnel Chest* ; Heart* ; Humans ; Male ; Marfan Syndrome* ; Mitral Valve ; Mitral Valve Insufficiency ; Ribs ; Sternotomy ; Thoracic Surgery*

OBJECTIVETo evaluate the short-term effect and experience of Nuss procedure on 120 cases of patients with pectus excavatum.

METHODSThoracoscopy assisted Nuss procedure with different ways of anesthesia were applied to 120 cases of patients with pectus excavatum, including 7 cases of recurrence after traditional surgical procedure (6 cases) and Nuss method (another one). The patients ranged in age from 2.5 to 43 (mean 14.1) years and in Haller index from 2.91 to 29. Of the 120, 73 had symmetric and 47 had asymmetric pectus excavatum. The Nuss procedure is performed with general anesthesia and a convex steel bar is inserted under the sternum with thoracoscopy through small bilateral thoracic incisions. The steel bar is inserted with the convexity facing posteriorly, and when it is in position, the bar is turned over, thereby correcting the deformity.

RESULTSThe operation was successfully accomplished without severe complications in all the 120 cases. The mean operative time was 58 minutes and the mean volume of blood loss was 30 ml. 103 patients had one bar inserted while the other 17 cases with more extremely diffuse depression required 2 or even 3 bars to get a satisfactory correction. Such methods as modifications to the fixing points and the shape of the bar, partial osteotomy, were developed to deal with asymmetric ones.

CONCLUSIONThe Nuss procedure is a minimally invasive technique for correction of pectus excavatum. It can lead to a satisfactory outcome and surgical time is less.

Adolescent ; Adult ; Child ; Child, Preschool ; Female ; Funnel Chest ; surgery ; Humans ; Male ; Orthopedic Procedures ; methods ; Thoracoscopy ; Young Adult

BACKGROUNDFunnel chest has a negative effect on adolescents and it has a strong effect on adolescents' psychological and behavior. This study aimed to investigate the psychological characteristics and factors that affect adolescents with funnel chest and to evaluate the relationship between the patients' age and their physiological and psychological health. We aimed to establish an age model for maximum surgery benefits for funnel chest patients to provide an objective basis for choosing surgery.

METHODSThe study adopted a general evaluation approach to assess the risk and benefits of minimally invasive surgery for funnel chest. The funnel chest index, the Symptom Checklist-90, and the Eysenck Personality Questionnaire were used as assessment tools to observe physiological and psychological features in funnel chest patients. A sample of 234 adolescents with funnel chest was selected from a third-grade class-A hospital in Beijing. Age groups were adopted as an independent variable, and other factors in funnel chest patients were dependent variables.

RESULTSThere was a significant difference in the relapse rate for funnel chest in the different age groups (χ(2) = 11.883, P = 0.008). There was a higher relapse rate in patients of ≤10 or ≥19 years old than in patients of 11-18 years old. There was a significant difference in the SCL-90 total score in the different age groups (F = 12.538, P = 0.0001), the patients older than 13 years had a higher score than those younger than 13 years in the SCL-90. There was a significant difference in the standard score of E (introversion/ extraversion) in the different age groups (F = 10.06, P = 0.0001). There was also a significance in the funnel chest index before surgery in the different psychological scales (P < 0.01), with a higher funnel chest index score associated with more obvious psychological trauma. Age and the number of variables, including the relapse rate, SCL-90 score, standard score of E, and standard score of N in the EPQ were significantly correlated (correlation indices were 0.402, 0.623, -0.505, and 0.473, respectively, P < 0.01).

CONCLUSIONSThere are higher complication rates after surgery and relapse rates when funnel chest patients are too young or too old. There is more obvious psychological trauma in patients with a high funnel chest index. Our results indicate that the best age for surgery for funnel chest is 14-16 years.

Adolescent ; Adult ; Age Factors ; Child ; Funnel Chest ; psychology ; surgery ; Humans ; Minimally Invasive Surgical Procedures ; Psychological Tests ; Psychology, Adolescent