CHEST-WALL CONSTRICTION AFTER TOO EXTENSIVE AND TOO EARLY OPERATIONS FOR PECTUS-EXCAVATUM

Background and Methods. Since 1990 we have evaluated 12 children and t eenagers in whom severe cardiorespiratory symptoms have developed due to failure of chest wall growth after very extensive pectus excavatum operations (removal of five or more ribs) at very early ages (<4 years ). Results. Apparently these extensive procedures have removed or prev ented growth center activity, which resulted in restriction of chest w all growth with marked limitation of ventilatory function. The forced vital capacity ranged from 30% to 50% of predicted and the forced expi ratory volume in 1 second from 30% to 60%. All patients are symptomati c with mild exercise and cannot compete in running games. Our protocol for critical evaluation includes exercise pulmonary function studies and axial computed tomographic reconstruction. Conclusions. This repor t is an alert to recognize such patients and also to recommend delay i n operative repair in small children until at least 6 to 8 years of ag e. The younger the patient the more limited the chest wall resection f or pectus excavatum should be. Five of these patients have had a chest cavity expansion operation with encouraging early results.