ABSTRACT
<p>A 55-year-old man presented with exertional dyspnea. He was found to have an incomplete atrioventricular septal defect (AVSD), mitral regurgitation, a patent foramen ovale (PFO), atrial fibrillation, and pectus excavatum. A one-stage operation including thoracoplasty in addition to the intracardiac repair was preferred in order to obtain a good view of the operative field and control the postoperative hemodynamics. Therefore, we performed autologous pericardial patch closure of the AVSD, mitral valve plasty with closure of the mitral cleft, direct closure of the PFO, and a modified maze procedure, followed by sternal elevation (modified Ravitch procedure) during chest closure. Postoperatively, his respiratory status on a respirator improved slowly and he was extubated on the 17th postoperative day. Dysphagia developed because of the prolonged intubation, but improved with deglutition rehabilitation. The subsequent postoperative course was uneventful and he was discharged on the 59th postoperative day. We performed a modified Ravitch procedure, instead of sternal turnover, because the latter requires exfoliating a broad area, which could increase the total blood loss and the risk of infection, and make it difficult to maintain the blood flow of the plastron. We obtained a good view of the operative field and stable hemodynamics postoperatively with sternal elevation in pectus excavatum accompanied by heart disease.</p>
ABSTRACT
Objective To review the experience of modified sternal elevation in management of pectus excavatum deformities. Methods A retrospective study was carried out on 268 children with pectus excavatum deformities from January 2002 to December 2005.Of these patients,213 were boys and 55 were girls.Their age ranged from 2 to 16 years and 2 months[mean,(4.48?2.74) years)].Among then,69 cases were aged from 2 to 3 years,130 cases from 3 to 6 years and 69 cases over 6 years.268 patients with PE underwent modified sternal elevation and fixation with the home made stainless steel strut.The lung cysts,esophageal hatal hernia and congenital heart diseases were surgical treated simultaneously.Results There was no death postoperative.Postoperative compli- cations included pneumonia in 1 case,subcutaneous fluid in 2.the foUow-up period was 1-5 years.One patient was found having light notch in sternum.All patients had satisfactory results.In 165 cases stainless steel strut have been taken off postoperatively and no recurrence occurred.Conclusion The modified sternal elevation procedure for pectus excavatum results in an excellent cosmetic outcome.
ABSTRACT
Objective:To review the surgical experience with pectus excavatum deformities in infants.Methods:Retrospective study was carried out on 43 infants with pectus excavatum deformities from January 1994 to October 2001.There were 31 male patients and 12 female patients.40 patients with PE underwent modified sternal elevation and 3 sternal turn-over operation.Results:Except one case of associated pneumonia and another of wound infection,the other cases had normal contours.The follow-up period was 6 months～7 years postoperatively.Except that two had logical notch and one had a flat contour in thorax,all patients had satisfactory results.Conclusion:Pectus excavatum deformities can be early operated.Correction of pectus excavatum by using sternal elevation procedure and fixation with Lucite results in an excellent cosmetic outcome.