Chest Wall Deformities Categories of Congenital Anterior Chest Wall Deformities 1. Pectus excavatum...
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Transcript of Chest Wall Deformities Categories of Congenital Anterior Chest Wall Deformities 1. Pectus excavatum...
![Page 1: Chest Wall Deformities Categories of Congenital Anterior Chest Wall Deformities 1. Pectus excavatum 2. Pectus carinatum 3. Poland’s syndrome 4. Sternal.](https://reader035.fdocuments.net/reader035/viewer/2022081504/56649cff5503460f949d1512/html5/thumbnails/1.jpg)
Chest Wall Deformities
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Categories of Congenital Anterior Chest Wall Deformities
• 1. Pectus excavatum
• 2. Pectus carinatum
• 3. Poland’s syndrome
• 4. Sternal defects
• 5. Miscellaneous
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Congenital Heart Disease Associated with Pectus Excavatum and Pectus Carinatum
• Aortic ring
• AR
• ASD
• VSD
• TOF
• PDA
• TGA
• Ebstein’s malformation
• TAPVR
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Pectus Excavatum( Funnel Chest )
• Pectus excavatum is posterior depression of the sternum and costal cartilage due to over grow of costal cartilage.
• The 1st and 2nd ribs, manubrium are in normal position.
• Asymmetrical of the depression may be present and the right is often more depressed than the left.
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Pectus Excavatum
• Pectus excavatum is present at birth or within the 1st year of life in most patients.
• It may worsen at adolescent.
• It may be associated with scoliosis, asthma.
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Etiology and Incidence of Pectus Excavatum
• It is reported 1/( 300 to 400) of lives birth and rare in blacks.
• M:F=4:1
• Etiology is unknown.
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M-S Abnormalities with Pectus Excavatum
• Scoliosis
• Kyphosis
• Myopathy
• Marfan’s syndrome
• Cerebral palsy
• Prune-belly syndrome
• Tuberous sclerosis
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Symptoms of Pectus Excavatum
• It is well tolerated in infants and children.
• Older child may have precordial pain after exercise
• Palpitation may be present due to atrial arrythmia.
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Pathophysiology of Pectus Excavatum
• Systolic murmur results from close proximity of the sternum and the pulmonary artery.
• EKG abnormality results from displacement of and rotation of the heart into the left thoracic cavity.
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Pulmonary Function Study of Pectus Excavatum
• The maximum voluntary ventilation is lower than normal.
• Some studies shows deterioration in pulmonary function after surgery due to increased rigidity of chest wall.
• Exercise tolerance is improved after surgery.
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Cardiovascular Study of Pectus Excavatum
• Anterior identation of right ventricle is present.
• Elevated right heart pressure is present.• In pectus excavatum, increased cardiac outp
ut on exertion is due to increased heart rate rather than stroke volume.
• Echo reveals mitral valve prolapse, which can subside after surgery.
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Sugical Repair of Pectus Excavatum
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Complications of Surgery of Pectus Excavatum
• Pneumothorax
• Wound infection
• Wound hematoma
• Pneumonia
• Seroma
• Recurrence
• Hemopericardium
• Hemoptysis
• Wound dehescence
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Complications of Surgery of Pectus Excavatum
• The most distressing complication is major recurrence.
• Major recurrence is present frequently with poor muscular and asthenic or marfanoid habitus.
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Complications of Surgery of Pectus Excavatum
• Chest growth impairment may be present if costal cartilage is resected too much.
• Delaying the surgery until the child is older and preserving costochondral junction with a segemnt on the rib can avoid delayed thoracic growth.
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Pectus Carinatum( Pigeon Chest )
• It refers anterior protrusion of the sternum.
• It is less common than pectus excavatum.
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Categories of Pectus Carinatum
• 1. Chondrogladiolar
(1) It is most common pectus
carinatum .
(2) It consists of anterior protrusion of the
body of sternum and lower costal
cartilages.
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Categories of Pectus Carinatum
• 2. Mixed with excavatum and carinatum
It consists carinatum on one side and
excavatum on another side.
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Categories of Pectus Carinatum
• 3. Chondromanubrial
(1) It is the most uncommon pectus carinatum.
(2) It consists protrusion of manubrium,
2nd and 3rd costal cartilages with
relative depression of the body and
sternum.
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Etiology of Pectus Carinatum
• The etiology is unknown and genetic basis is favored.
• It is more common in boys than girls.
• It may be associated with M-S abnormality and congenital heart disease.
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Surgical Repair of Pectus Carinatum
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Poland’s Syndrome
• It refers congenital absence of the pectoralis major and minor muscles, ribs, breast abnormality, chest wall depression and syndactyly( or brachydactyly, ectromelia ).
• It is present in 1/30000.
• The etiology is unknown.
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Surgical Repair of Poland’s Syndrome
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Sternal Defects
• 1. Cleft sternum
• 2. Ectopia cordis
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Thoracic Deformities in Diffuse Skeletal Disorders
1. Asphyxiating thoracic dystrophy( Jeune’s
syndrome )
2. Spondylothoracic dysplasia( Jarcho-Levin
syndrome)