Chest Wall Deformities

Categories of Congenital
Anterior Chest Wall Deformities
• 1. Pectus excavatum
• 2. Pectus carinatum
• 3. Poland’s syndrome
• 4. Sternal defects
• 5. Miscellaneous
Congenital Heart Disease Associated with Pe
ctus Excavatum and Pectus Carinatum
• Aortic ring
• AR
• ASD
• VSD
• TOF
• PDA
• TGA
• Ebstein’s malformation
• TAPVR
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 norm
al position.
• Asymmetrical of the depression may be pre
sent and the right is often more depressed th
an the left.
 Pectus Excavatum
• Pectus excavatum is present at birth or with
in the 1st year of life in most patients.
• It may worsen at adolescent.
• It may be associated with scoliosis, asthma.
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.
M-S Abnormalities with Pectus E
xcavatum
• Scoliosis
• Kyphosis
• Myopathy
• Marfan’s syndrome
• Cerebral palsy
• Prune-belly syndrome
• Tuberous sclerosis
Symptoms of Pectus Excavatum
• It is well tolerated in infants and children.
• Older child may have precordial pain after e
xercise
• Palpitation may be present due to atrial arry
thmia.
Pathophysiology of Pectus Excav
atum
• 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.
Pulmonary Function Study of Pe
ctus 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.
Cardiovascular Study of Pectus E
xcavatum
• Anterior identation of right ventricle is pres
ent.
• 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 c
an subside after surgery.
Sugical Repair of Pectus Excavat
um
Complications of Surgery of Pect
us Excavatum
• Pneumothorax
• Wound infection
• Wound hematoma
• Pneumonia
• Seroma
• Recurrence
• Hemopericardium
• Hemoptysis
• Wound dehescence
Complications of Surgery of Pect
us Excavatum
• The most distressing complication is major
recurrence.
• Major recurrence is present frequently with
poor muscular and asthenic or marfanoid ha
bitus.
Complications of Surgery of Pect
us 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 thor
acic growth.
 Pectus Carinatum
( Pigeon Chest )

• It refers anterior protrusion of the sternum.

• It is less common than pectus excavatum.
 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.
 Categories of Pectus Carinatum

• 2. Mixed with excavatum and carinatum

It consists carinatum on one side and
excavatum on another side.
 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.
 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.
Surgical Repair of Pectus Carinat
um
 Poland’s Syndrome
• It refers congenital absence of the pectoralis
major and minor muscles, ribs, breast abnor
mality, chest wall depression and syndactyl
y( or brachydactyly, ectromelia ).
• It is present in 1/30000.
• The etiology is unknown.
Surgical Repair of Poland’s
Syndrome
 Sternal Defects

• 1. Cleft sternum
• 2. Ectopia cordis
Thoracic Deformities in Diffuse
Skeletal Disorders
1. Asphyxiating thoracic dystrophy( Jeune’s
syndrome )
2. Spondylothoracic dysplasia( Jarcho-Levi
n
syndrome)