1. Chest Wall Deformities

2. Categories of Congenital Anterior Chest Wall Deformities
1. Pectus excavatum
2. Pectus carinatum
3. Poland’s syndrome
4. Sternal defects
5. Miscellaneous

3. Congenital Heart Disease Associated with Pectus Excavatum and Pectus Carinatum
Aortic ring AR
ASD
VSD
TOF
PDA
TGA
Ebstein’s malformation
TAPVR

4. 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 normal position.
Asymmetrical of the depression may be present and the right is often more depressed than the left.

5. Pectus Excavatum
Pectus excavatum is present at birth or within the 1st year of life in most patients.
It may worsen at adolescent.
It may be associated with scoliosis, asthma.

6. 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.

7. M-S Abnormalities with Pectus Excavatum
Scoliosis
Kyphosis
Myopathy
Marfan’s syndrome
Cerebral palsy
Prune-belly syndrome
Tuberous sclerosis

8. Symptoms of Pectus Excavatum
It is well tolerated in infants and children.
Older child may have precordial pain after exercise
Palpitation may be present due to atrial arrythmia.

9. Pathophysiology of Pectus Excavatum
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.

10. Pulmonary Function Study of Pectus 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.

11. Cardiovascular Study of Pectus Excavatum
Anterior identation of right ventricle is present.
Elevated right heart pressure is present.
In pectus excavatum, increased cardiac output on exertion is due to increased heart rate rather than stroke volume.
Echo reveals mitral valve prolapse, which can subside after surgery.

12. Sugical Repair of Pectus Excavatum

13. Complications of Surgery of Pectus Excavatum
Pneumothorax
Wound infection
Wound hematoma
Pneumonia
Seroma
Recurrence
Hemopericardium
Hemoptysis
Wound dehescence

14. Complications of Surgery of Pectus Excavatum
The most distressing complication is major recurrence.
Major recurrence is present frequently with poor muscular and asthenic or marfanoid habitus.

15. Complications of Surgery of Pectus 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 thoracic growth.

16. Pectus Carinatum ( Pigeon Chest )
It refers anterior protrusion of the sternum.
It is less common than pectus excavatum.

17. 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.

18. Categories of Pectus Carinatum
2. Mixed with excavatum and carinatum
It consists carinatum on one side and
excavatum on another side.

19. 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.

20. 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.

21. Surgical Repair of Pectus Carinatum

22. Poland’s Syndrome
It refers congenital absence of the pectoralis major and minor muscles, ribs, breast abnormality, chest wall depression and syndactyly( or brachydactyly, ectromelia ).
It is present in 1/30000.
The etiology is unknown.

23. Surgical Repair of Poland’s Syndrome

24. Sternal Defects
1. Cleft sternum
2. Ectopia cordis

25. Thoracic Deformities in Diffuse Skeletal Disorders
1. Asphyxiating thoracic dystrophy( Jeune’s
syndrome )
2. Spondylothoracic dysplasia( Jarcho-Levin
syndrome)