CARDIOVASCULAR JOURNAL OF AFRICA • Vol 24, No 8, September 2013
318
AFRICA
Clinical experience of repair of pectus excavatum and
carinatum deformities
MURAT ONCEL, BEKIR TEZCAN, KAZIM GUROL AKYOL, YÜKSEL DERELI, GÜVEN SADI SUNAM
Abstract
Background:
We present the results of surgical correc-
tion of pectus excavatum (PE) and pectus carinatum (PC)
deformities in adults, and also report a new method of sternal
support used in surgery for PE deformities.
Methods:
We present the results of 77 patients between the ages
of 10 and 29 years (mean 17) with PE (
n
=
46) or PC (
n
=
31)
deformities undergoing corrective surgery from 2004 to 2011,
using the Ravitch repair method. Symptoms of the patients
included chest pain (15%) and tachycardia (8%). Three
patients underwent repair of recurrent surgical conditions.
Results:
All of the patients with dyspnoea with exercise
experienced marked improvement at five months post opera-
tion. Complications included pneumothorax in 5.1% (
n
=
4),
haemothorax in 2.6% (
n
=
2), chest discomfort in 57% (
n
=
44), pleural effusion in 2.6% (
n
=
2), and sternal hypertrophic
scar in 27% (
n
=
21) of patients. Mean hospitalisation was
eight days. Pain was mild and intravenous analgesics were
used for a mean of four days. There were no deaths. Results
after surgical correction were very good or excellent in 62
patients (80%) at a mean follow up of three years. Three
patients had recurrent PE and were repaired with the Nuss
procedure. In three patients who underwent the Ravitch
procedure, a stainless steel bar was used for sternal support
instead of Kirschner wire.
Conclusions:
Pectus deformities may be repaired with no
mortality, low morbidity, very good cosmetic results and
improvement in cardiological and respiratory symptoms.
Keywords:
pectus excavatum, pectus carinatum, modified
Ravitch procedure, internal bar
Submitted 24/3/13, accepted 4/9/13
Cardiovasc J Afr
2013;
24
: 318–321
DOI: 10.5830/CVJA-2013-065
Pectus excavatum (PE) may be as common as one in 300
live births.
1
It is usually noticed within the first year of life.
Sternal depression becomes much more pronounced in early
adolescence during rapid skeletal growth. PE is well tolerated in
infancy but adult patients may suffer from poor chest movement
in areas of the deformed cartilage, often resulting in serious
exercise intolerance. The heart is often displaced to the left chest
by the depressed sternum. Posterior displacement of the sternum
can produce a deformity of the heart, specifically the anterior of
the right ventricle.
2
Exercise tolerance is usually improved after
operation for PE.
Pectus carinatum (PC) is the best recognised and most
frequent protrusion deformity of the chest wall.
1
PC is usually
identified up to the 11th birthday. Mixed deformities have a
carinate deformity on one side and a depression or excavatum
deformity on the contralateral side.
This study aimed to determine the results of surgical correction
of PE and PC deformities in adults. We also report a new method
of sternal support used in surgery for PE deformities.
Methods
Patients between the ages of 10 and 22 years who underwent
correction of PE and PC deformities at the Konya State Hospital
and Faculty of Medicine, Selcuk University, between January
2004 and December 2010, were reviewed (Figs 1, 2). Indications
for the operation included Haller index of 3.25 or greater,
abnormal respiratory function test, or concerning findings after
cardiological evaluation.
Computed tomography (CT) of the chest was used to evaluate
the severity of the deformity. The pectus index was calculated as
A divided by C, where A is the greatest latero-lateral distance
and C is the shortest antero-posterior distance.
3
Chest X-ray, ECG, respiratory function tests and CT were
routinely performed on all patients before operating (Fig. 3).
All patients were examined by cardiological consultation, and
Department of Thoracic Surgery, Faculty of Medicine,
Selcuk University, Konya, Turkey
MURAT ONCEL, MD,
GÜVEN SADI SUNAM, MD
Department of Thoracic Surgery, Konya State Hospital,
Konya, Turkey
BEKIR TEZCAN, MD
KAZIM GUROL AKYOL, MD
Department of Cardiovascular Surgery, Faculty of Medicine,
Necmettin Erbakan University, Konya, Turkey
YÜKSEL DERELI, MD
Fig. 1. A patient with pectus excavatum.
