LONG-TERM RESULTS AFTER CORRECTION OF ANTERIOR CHEST-WALL DEFORMITIES

Background. Surgical correction of pectus deformities was mainly perfo rmed for cosmetic and psychologic reasons but eventual cardiopulmonary symptoms improved. Whether this results from alterations in cardiopul monary physiology is still controversial. Methods. In 25 years 662 pat ients underwent correction (390 for pectus excavatum-funnel chest, 235 for pectus carinatum-chicken chest, 37 for pectus arcuatum -pouter pi geon chest). Surgical correction was mainly performed for cosmetic and psychologic reasons. Sternochondroplasty was performed without prosth etic material. Results. Clinical results for funnel chest were satisfa ctory in 83.6% (excellent 44.1%, good 39.5%) and were always good for protrusion deformities if enough deformed cartilages were resected. In a retrospective study the pulmonary function tests performed on 152 p atients with funnel chest before surgery and at longterm follow-up dem onstrated an eventual increased restriction at follow-up, despite symp tomatic improvement and increased anteroposterior chest diameter on th e X-ray, but restricted anterior chest wall motion. In a prospective s tudy the exercise cardiorespiratory function tests on 35 patients with funnel chest before and one year after operation suggested unchanged work performance, but an increased oxygen consumption and acidificatio n due to a higher work of breathing after operation, caused by decreas ed chest wall compliance. Conclusions. The subjective physical improve ment after operation cannot be explained by changes in static lung vol umes or in cardiorespiratory function at exercise, but is due to other unexplained factors. Satisfactory subjective long-term results of mos t patients justify surgical correction. Both physical as well as psych ologic and cosmetic factors may allow operative correction.