Semin Plast Surg 2011; 25(1): 107-116
DOI: 10.1055/s-0031-1275177
© Thieme Medical Publishers

Management of Congenital Chest Wall Deformities

Felix C. Blanco1 , Steven T. Elliott2 , Anthony D. Sandler3
  • 1Department of Surgery, Children's National Medical Center, Washington, DC
  • 2UC Davis Medical Center, Sacramento, California
  • 3Division of Pediatric Thoracic and General Surgery, Children's National Medical Center, Washington, DC
Further Information

Publication History

Publication Date:
05 April 2011 (online)

ABSTRACT

Congenital chest wall deformities are considered to be anomalies in chest wall growth. These can be categorized as either rib cage overgrowth or deformities related to inadequate growth (aplasia or dysplasia). Rib cage overgrowth leads to depression of the sternum (pectus excavatum) or protuberance of the sternum (pectus carinatum) and accounts for greater than 90% of congenital chest wall deformities. The remaining deformities are a result of inadequate growth. Evolution in the management of congenital chest wall deformities has made significant progress over the past 25 years. This article will review chest wall deformities and the current management strategies of these interesting anomalies.

REFERENCES

  • 1 Nuss D, Croitoru D P, Kelly R E. Congenital chest wall deformities. In: Ashcraft K W, Holcomb III G W, Murphy J P, eds. Pediatric Surgery, 4th edition. Philadelphia: Elsevier Saunders; 2005: 245-63
  • 2 Engum S A. Embryology, sternal clefts, ectopia cordis, and Cantrell's pentalogy.  Semin Pediatr Surg. 2008;  17 154-160
  • 3 Kotzot D, Schwabegger A H. Etiology of chest wall deformities—a genetic review for the treating physician.  J Pediatr Surg. 2009;  44 2004-2011
  • 4 Haller Jr J AJ, Kramer S S, Lietman S A. Use of CT scans in selection of patients for pectus excavatum surgery: a preliminary report.  J Pediatr Surg. 1987;  22 904-906
  • 5 Mueller C, Saint-Vil D, Bouchard S. Chest x-ray as a primary modality for preoperative imaging of pectus excavatum.  J Pediatr Surg. 2008;  43 71-73
  • 6 Bawazir O A, Montgomery M, Harder J, Sigalet D L. Midterm evaluation of cardiopulmonary effects of closed repair for pectus excavatum.  J Pediatr Surg. 2005;  40 863-867
  • 7 Ravitch M M. The operative treatment of pectus excavatum.  Ann Surg. 1949;  129 429-444
  • 8 Hecker W C, Procher G, Dietz H G. Results of operative correction of pigeon and funnel chest following a modified procedure of Ravitch and Haller [author's transl].  Z Kinderchir. 1981;  34 220-227
  • 9 Nasr A, Fecteau A, Wales P W. Comparison of the Nuss and the Ravitch procedure for pectus excavatum repair: A meta-analysis.  J Pediatr Surg. 2010;  45 880-886
  • 10 Harrison M R, Curran P F, Jamshidi R et al.. Magnetic mini-mover procedure for pectus excavatum II: Initial findings of a Food and Drug Administration-sponsored trial.  J Pediatr Surg. 2010;  45 185-191 discussion 191-192
  • 11 Haecker F-M, Mayr J. The vacuum bell for treatment of pectus excavatum: An alternative to surgical correction?.  Eur J Cardiothorac Surg. 2006;  29 557-561
  • 12 Nehra D, Ein S H, Tlumacki M, Masiakos P T. Pectus carinatum: To brace or not to brace—a picture is worth 1770 words.  J Prosthet Orthot. 2009;  21 167-170
  • 13 Abramson H. A minimally invasive technique to repair pectus carinatum. Preliminary report.  Arch Bronconeumol. 2005;  41 349-351
  • 14 Jesudason E C. Challenging embryological theories on congenital diaphragmatic hernia: Future therapeutic implications for paediatric surgery.  Ann R Coll Surg Engl. 2002;  84 252-259
  • 15 Harting M T, Lally K P. Surgical management of neonates with congenital diaphragmatic hernia.  Semin Pediatr Surg. 2007;  16 109-114
  • 16 Bryner B S, West B T, Hirschl R B Congenital Diaphragmatic Hernia Study Group et al. Congenital diaphragmatic hernia requiring extracorporeal membrane oxygenation: Does timing of repair matter?.  J Pediatr Surg. 2009;  44 1165-1171 discussion 1171-1172
  • 17 Guner Y S, Chokshi N, Aranda A et al.. Thoracoscopic repair of neonatal diaphragmatic hernia.  J Laparoendosc Adv Surg Tech A. 2008;  18 875-880
  • 18 Padalino M A, Zanon G F, Migneco F, Rubino M G, Fusaro F, Stellin G. Surgical repair of incomplete cleft sternum and cardiac anomalies in early infancy.  Ann Thorac Surg. 2006;  81 2291-2294
  • 19 Fisher J C, Haley M J, Ruiz-Elizalde A, Stolar C J, Arkovitz M S. Multivariate model for predicting recurrence in congenital diaphragmatic hernia.  J Pediatr Surg. 2009;  44 1173-1179 discussion 1179-1180
  • 20 Darian V B, Argenta L C, Pasyk K A. Familial Poland's syndrome.  Ann Plast Surg. 1989;  23 531-537
  • 21 Sadove A M, van Aalst J A. Congenital and acquired pediatric breast anomalies: A review of 20 years' experience.  Plast Reconstr Surg. 2005;  115 1039-1050
  • 22 Shamberger R C, Welch K J, Upton III J. Surgical treatment of thoracic deformity in Poland's syndrome.  J Pediatr Surg. 1989;  24 760-765 discussion 766
  • 23 Shamberger R C. Congenital chest wall deformities.  Curr Probl Surg. 1996;  33 469-542
  • 24 Acastello E, Majluf R, Garrido P, Barbosa L M, Peredo A. Sternal cleft: A surgical opportunity.  J Pediatr Surg. 2003;  38 178-183
  • 25 Mathai J, Cherian V K, Chacko J et al.. Bridging the cleft over the throbbing heart.  Ann Thorac Surg. 2006;  82 2310-2311
  • 26 Cantrell J R, Haller J A, Ravitch M M. A syndrome of congenital defects involving the abdominal wall, sternum, diaphragm, pericardium, and heart.  Surg Gynecol Obstet. 1958;  107 602-614
  • 27 van Hoorn J H, Moonen R M, Huysentruyt C J, van Heurn L W, Offermans J P, Mulder A L. Pentalogy of Cantrell: Two patients and a review to determine prognostic factors for optimal approach.  Eur J Pediatr. 2008;  167 29-35
  • 28 Morgan N V, Bacchelli C, Gissen P et al.. A locus for asphyxiating thoracic dystrophy, ATD, maps to chromosome 15q13.  J Med Genet. 2003;  40 431-435
  • 29 den Hollander N S, Robben S G, Hoogeboom A J, Niermeijer M F, Wladimiroff J W. Early prenatal sonographic diagnosis and follow-up of Jeune syndrome.  Ultrasound Obstet Gynecol. 2001;  18 378-383
  • 30 Davis J T, Ruberg R L, Leppink D M, McCoy K S, Wright C C. Lateral thoracic expansion for Jeune's asphyxiating dystrophy: A new approach.  Ann Thorac Surg. 1995;  60 694-696
  • 31 Hell A K, Campbell R M, Hefti F. The vertical expandable prosthetic titanium rib implant for the treatment of thoracic insufficiency syndrome associated with congenital and neuromuscular scoliosis in young children.  J Pediatr Orthop B. 2005;  14 287-293

Anthony D SandlerM.D. F.A.C.S. 

Diane and Norman Bernstein Professor of Pediatric Surgery, Chief, Division of Pediatric Thoracic and General Surgery

Children's National Medical Center, 111 Michigan Ave., NW. Washington, DC 20010-2970

Email: asandler@cnmc.org

    >