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A 26-year review of pectus deformity repairs, including simultaneous intracardiac repair

A 26-year review of pectus deformity repairs, including simultaneous intracardiac repair

Authors :
Charles L Willekes
Carl L. Backer
Constantine Mavroudis
Source :
The Annals of Thoracic Surgery. 67:511-518
Publication Year :
1999
Publisher :
Elsevier BV, 1999.

Abstract

Background . We reviewed our operative experience and long-term results with repair of pectus excavatum and carinatum deformities through a vertical midline approach, including those cases with simultaneous intracardiac repair. Methods . From 1972 through 1998, 120 children underwent pectus deformity repair. Operative technique used a vertical midline incision with subperichondrial resection of deformed cartilages and an anterior sternal osteotomy. Thirty-five patients had a temporary metal bar for retrosternal support for 6 months; 85 underwent repair without a bar. Patients and parents were asked to assess the outcome after pectus repair as poor, fair, good, or excellent. Results . There were 94 male and 26 female patients (mean age, 8.4 years; range, 3 to 21 years). There were 111 cases of pectus excavatum and 9 of pectus carinatum. Fourteen children (11.5%) had an associated congenital heart defect; 9 patients had simultaneous pectus and intracardiac repair. One patient was referred for emergent open heart repair and pectus repair after attempted "Nuss" repair resulted in a perforated right atrium, perforated right ventricle, and partially disrupted tricuspid valve apparatus. There were no deaths and only one significant complication, which required a return to the operating room for bleeding. Morbidity was not higher in patients with simultaneous intracardiac repair. Long-term follow-up was established in 83% of patients. Results were classified as excellent in 64 patients (64%), good in 25 (25%), fair in 8 (8%), and poor in 3 (3%). Thirty (86%) of 35 patients with a sternal bar had excellent results versus 34 (52%) of 65 without a bar ( p = 0.004); 97% of patients who underwent repair with a sternal bar classified the result as excellent or good. Conclusions . Long-term results of pectus excavatum and carinatum repair through a vertical midline approach are excellent. Outcome with a temporary sternal bar is superior to outcome without a bar. Concomitant repair of congenital heart defects and pectus deformity may be performed successfully without additional morbidity.

Details

ISSN :
00034975
Volume :
67
Database :
OpenAIRE
Journal :
The Annals of Thoracic Surgery
Accession number :
edsair.doi.dedup.....bc6ce52bcc32355fb80b2633ea0cbe4a
Full Text :
https://doi.org/10.1016/s0003-4975(99)00015-6