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Pectus excavatum (PE).  There is a large group of congenital abnormalities of the thoracic cage that manifest as deformities of the anterior chest wall.

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Presentation on theme: "Pectus excavatum (PE).  There is a large group of congenital abnormalities of the thoracic cage that manifest as deformities of the anterior chest wall."— Presentation transcript:

1 Pectus excavatum (PE)

2  There is a large group of congenital abnormalities of the thoracic cage that manifest as deformities of the anterior chest wall.

3 Question: How many groups of the deformities of the anterior chest wall ?

4 Answer This diverse group includes : 1. pectus excavatum 2. pectus carinatum 3. Pouter pigeon breast 4. poland syndrome 5. cleft sternum

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7 Pectus excavatum (PE) is the most common chest wall malformation and one of the most frequent major congenital anomalies. It approximately occurs in 1 in every 400 births, with a 4:1 male predominance.

8 In patients with PE, the sternum and adjacent chest wall are displaced posteriorly toward the spine, creating a depression of the anterior chest wall.

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10 A preoperative computed tomography (CT) chest scan is currently recommended by some authors to evaluate the extent of the deformity and to plan repair.

11 Non-enhanced CT scanning.

12 Pathogenesis The currently accepted etiologic theory is that excessive growth of the lower costalb cartilages (gristle)occurs that forces the sternum into a concave position. The reason for this overgrowth of costal cartilages, which frequently increases the severity of the deformity in the preschool-age child and again during the pubertal years, is currently unknown.

13 Symptoms Symptoms are infrequent during early childhood, apart from a shy awareness of the abnormality and a typical unwillingness to expose the chest while swimming or taking part in other social or athletic activities.

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15 It is particularly important that this deformity be corrected, if possible, before the child starts school,because it may cause severe psychologica ( mental ) and emotional damage.

16 During early adolescence Easy fatigability Shortness of breath with mild exercise Decreased stamina Tachycardia ( bradycardia ),and/or palpitations are common Pectus excavatum patients commonly try hard to keep up with their peers physically

17 Who? PE ? pectorales

18 Treatment Resect a major portion of the deformed costal cartilages 。 The sternal osteotomy and resection of short segments of cartilages from the deformed ribs.

19 A new minimally invasive ( invade ) technique for repair of PE (MIRPE) was reported by Nuss et al. in 1998 for young children (mean age under 5 years)

20 Donald Nuss

21 The Nuss procedure Minimally invasive repair using a convex steel bar guided across the chest through a substernal tunnel and then twisted with a wrench to force the convex side anteriorly, which elevates the depressed sternum and deformed costal cartilages.

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23 Pre-operation

24 During-operation

25 post-operation X-ray

26 After-operation

27 Recent modifications of the MIRPE adopted by many surgeons include the use of thoracoscopy to visualize passage of the clamp behind the sternum

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29 References 1. Feng J, Hu T, Liu W, Zhang S, Tang Y, Chen R, Jiang X, Wei F:The biomechanical, morphologic, and histochemical properties of the costal cartilages in children with pectus excavatum.J Pediatr Surg 2001,36(12): Fokin AA, Steuerwald NM, Ahrens WA, Allen KE:Anatomical, histologic,and genetic characteristics of congenital chest wall deformities.Semin Thorac Cardiovasc Surg2009,21(1): Hebra A. Minimally invasive pectus surgery. Chest Surg. Clin. N. Am.2000;10:329 – Molik KA, Engum SA, Rescorla FJ, et al. Pectus excavatum repair:experience with standard and minimal invasive techniques. J. Pediatr.Surg. 2001;36:324 – Nuss D, Kelly RE Jr, Croitoru DP, et al. A ten-year review of a mini-mally invasive technique for the correction of pectus excavatum. J. Pe-diatr. Surg. 1998;33:545 – Eric W. Fonkalsrud, M.D. Current Management of Pectus Excavatum. World J. Surg. 27, 502 – 508, Martinez D, Juame J, Stein T, et al. The effect of costal cartilage resection on chest wall development. Pediatr. Surg. Int. 1990;5:170 – 173


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