Chest Wall Deformities

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Chest Wall Deformities
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Categories of Congenital Anterior Chest Wall
Deformities

• 1. Pectus excavatum
• 2. Pectus carinatum
• 3. Polands 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
• Ebsteins 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.
• MF41
• Etiology is unknown.

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M-S Abnormalities with Pectus Excavatum

• Scoliosis
• Kyphosis
• Myopathy
• Marfans 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 output 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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Polands 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 Polands 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( Jeunes
• syndrome )
• 2. Spondylothoracic dysplasia( Jarcho-Levin
• syndrome)