Pectus excavatum repair using a costal cartilage graft for patients with tracheobronchomalacia

Background. Pectus excavatum is sometimes associated with tracheobronchomal acia, which usually manifests left mediastinal shift, atelectasis of the le ft lung, and recurrent pulmonary infection. Standard repair of pectus excav atum alone usually failed to improve symptoms. Methods: Pexis of the great vessels and pericardium combined with the suppo rt of the lower sternum, using a contralateral costal cartilage graft follo wing the standard Ravitch's repair of pectus excavatum, has been used in 6 children during the past 5 years. In addition to respiratory symptoms, diag nosis of tracheobronchomalacia was made by bronchoscopy using an ultrathin fiberscope. Results: Using the described operative technique, an excellent cosmetic and functional result was obtained in 5 of 6 children. However, atelectasis of the left lower lobe and the narrowing of the left mainstem bronchus contin ued postoperatively in one patient, which required the insertion of the Pal maz stent in the left mainstem bronchus. Conclusion: This technique may help improve tracheobronchomalacia in patien ts with pectus excavatum and should be tried before the insertion of an int ernal stent. J Pediatr Surg 36:1650-1652. Copyright (C) 2001 by W.B. Saunde rs Company.