Medknow Publications on behalf of the Indian Association of Pediatric Surgeons
Abstract
This review article covers the spectrum of congenital thoracic wall
deformities along with their historical background. Willital′s
classification divides these deformities into 11 types - funnel chest
(4 types), pigeon chest (4 types), and combination of funnel and pigeon
chest, chest wall aplasia and cleft sternum. Records of patients at our
center comprised 90% depression deformities, 6% protrusion deformities,
3% combined depression-protrusion deformities and 1% other forms. Mild
forms of abnormalities warrant the wait- and-watch approach during the
first 4-5 years. The deformities manifest primarily during the pubertal
spurt often with rapid progression with subjective complaints like
dyspnea, cardiac dysthesia, limited work performance and secondary
changes. Operative correction in young adults is more favorable in mild
cases. The Willital technique has been the standard technique for the
correction of pectus excavatum, pectus carinatum and other combined
forms of deformities at our center with excellent long term results.
The Nuss procedure and the Pectus Less Invasive Extrapleural Repair
(PLIER) technique for pectus excavatum and pectus carinatum have also
been described in this article. Surgical correction for Poland′s
syndrome is reserved for patients with severe aplasia of the ribs with
major depression deformity. Sternal defects including various types of
ectopia cordis are discussed. Even after surgical correction, there is
significant reduction in the total capacity and inspiratory vital
capacity of the lungs, probably a result of the decreased compliance of
the chest wall. However, the efficiency of breathing at maximal
exercise improves significantly after operation