Pectus Excavatum

Ashok Johari
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Funnel Chest
It is a deformity marked by a sharp posterior curve of the body of sternum sweeping down from the manubrium which becomes deepest just before its junction with the xiphoid. The lower costal cartilages are also angled posteriorly towards the spine. The condition presents in the majority in first year of life and is 3 times more common in males. Genetic factors are active in its causation as 37% patients have family history of chest wall deformities. 15% patients have associated scoliosis. Most severe deformities occur in association with Marfan's syndrome. Congenital heart disease and asthma are occasional associations. Most surgeons document an increased activity and stamina in patients following surgical correction of the deformity. This is attributed to elimination of cardiopulmonary compromise which is believed to exist in these patients. However this is not clearly proven on laboratory cardiopulmonary assessment by many investigators.

Early surgery is recommended in this condition to prevent the development of symptoms or to correct those already present, to correct the orthopedic and cosmetic effect of this deformity and to correct the psychological response to the deformity. Operation is performed between 1 & 3 years of age or even before 1 year if the deformity is reliably noted to be progressive. Surgery usually includes resection of rib cartilage, lifting the sternum, sternal osteotomy and fixation with implants. Implants used are generally K-wires, but fixation with a steel plate as advised by Paltia is quite popular at present. Recently Poly Glycolic Acid (PGA) and Poly - L - Lactic Acid (PLLA) bio-degradable plates have also been used. Complications following surgical repair are limited. Recurrence of deformity is expected in 15%.


References
Pectus Excavatum Pectus Excavatum 02/20/2010
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