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Journal of Indian Association of Pediatric Surgeons
     Journal of Indian Association of Pediatric Surgeons
Official journal of the Indian Association of Pediatric Surgeons         
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 REVIEW ARTICLES
Year : 2005  |  Volume : 10  |  Issue : 3  |  Page : 147-157

Pectus excavatum, pectus carinatum and other forms of thoracic deformities


Department of Pediatric Surgical University Medical Centre, Münster, Germany

Correspondence Address:
Amulya K Saxena
Pediatric Surgical University Medical Centre, Albert Schweitzer Strasse 33, Münster, D-48149
Germany
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0971-9261.16964

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This review article covers the spectrum of congenital thoracic wall deformities along with their historical background. Willital's classification divides these deformities into 11 types - funnel chest (4 types), pigeon chest (4 types), and combination of funnel and pigeon chest, chest wall aplasia and cleft sternum. Records of patients at our center comprised 90% depression deformities, 6% protrusion deformities, 3% combined depression-protrusion deformities and 1% other forms. Mild forms of abnormalities warrant the wait- and-watch approach during the first 4-5 years. The deformities manifest primarily during the pubertal spurt often with rapid progression with subjective complaints like dyspnea, cardiac dysthesia, limited work performance and secondary changes. Operative correction in young adults is more favorable in mild cases. The Willital technique has been the standard technique for the correction of pectus excavatum, pectus carinatum and other combined forms of deformities at our center with excellent long term results. The Nuss procedure and the Pectus Less Invasive Extrapleural Repair (PLIER) technique for pectus excavatum and pectus carinatum have also been described in this article. Surgical correction for Poland's syndrome is reserved for patients with severe aplasia of the ribs with major depression deformity. Sternal defects including various types of ectopia cordis are discussed. Even after surgical correction, there is significant reduction in the total capacity and inspiratory vital capacity of the lungs, probably a result of the decreased compliance of the chest wall. However, the efficiency of breathing at maximal exercise improves significantly after operation.






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