• Journal of Chest Surgery
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• v.19 no.4
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• pp.699-706
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• 1986

We have experienced 5 cases of Pectus excavatum corrected by Ravitch method without use of K-wire or metal bar from Jan. 1985 to Apr. 1986. All cases were male. The symmetric depression was in 4 cases, asymmetric one was in one case. The chief complaints were dyspnea on exertion, frequent U.R.I. and inferiority. The flail chest was developed in all cases, but it was insignificant in all cases except one who needed assist ventilation. Mediastinitis was developed in one case one week postoperatively but well managed with drainage. A distance from the posterior surface of sternum to the anterior surface of vertebral body was estimated preoperatively and postoperatively. Postoperative result was evaluated as the change of distance postoperatively. The change was 1.5cm minimally to 3.5cm maximally. Late results were "Excellent" in 3 cases and "Good" in 2 cases.uot; in 2 cases.

• Journal of Chest Surgery
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• v.36 no.3
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• pp.164-174
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• 2003

Background: The Nuss procedure is a recently developed technique for minimally invasive repair of pectus excavatum using a metal bar. Although its technical simplicity and cosmetic advantages are remarkable, applications have been limited to children with standard pectus excavatum. We report a single center experience of the technique that has been evolving in order to correct asymmetric pectus configurations and adult patients. Material and Method: Between August 1999 and June 2002, 322 consecutive patients un-derwent repair by the Nuss technique and its modifications. Among them, 71 (22%) were adults. For the precise correction, morphology of the pectus was classified as symmetric and asymmetric types. Asymmetric type was subdivided into eccentric and unbalanced types. In repair, differently shaped bars were applied to individual types of pectus to achieve symmetric correction. Result: Symmetric type was 57.5% (185/322) and asymmetric type was 42.5% (137/322). Eccentric, unbalanced, and combined types were 71, 47 and 19, respectively, Major modifications were bar shaping and fixation. In asymmetric group, different shapes of asymmetric bars were applied (n=125, 38.8%). For adult patients, double bar or compound bar technique was used (n=51, 15.8%). To prevent bar rotation, multipoint wire fixations to ribs were used. Major postoperative complications were pneumothorax (n=24, 7.5%) and bar displacement (n=11, 3.4%). 42 patients had bar removal 2 years after the initial procedure. Conclusion: The Nuss procedure is safe and effective. Modifications of the techniques in accordance with precise morphological classification enabled the correction of all variety of pectus excavatum including asymmetric types and adult patients.

• Journal of Chest Surgery
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• v.39 no.10 s.267
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• pp.765-769
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• 2006

Background: Nuss procedure is a minimally invasive technique for correcting the pectus excavatum. But there are some limitations of correcting the complex anomaly or grown-up patients. Material and Method: we retrospectively reviewed 135 consecutive patients who underwent repair of pectus excavatum by the Nuss procedure and its modifications between November 1999 and December 2004. We analyzed the computed tomography, age on operation, operative technique, and complications. Result: We operated 135 patients of pectus excavatum during 62 months. Total number of operations about Nuss procedure is 216, including bar removal procedure of 64 cases, redo Nuss procedures of 47 cases. We modified the point of bar insertion to the hinge point, made a shoulder in the bar to prevent a displacement. And then we changed the fixation material from Vicryl to steel wire. If the patients are old, we retract the sternum during bar rotation and fixation. Until 2002, the number of redo Nuss operations were 17, complications were 23. but, after modifications, the number of redo Nuss operation were 0, complications were 2. Conclusion: This result indicates that our modifications of Nuss operation is effective, and could decrease the number of redo Nuss operation and complications.

• Journal of Chest Surgery
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• v.35 no.7
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• pp.556-559
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• 2002

The presense of pectus excavatum in Marfan's syndrome may complicate cardiac operation by making midline sternotomy technically more difficult and limiting the operative exposure of the heart. We operated on a 33 year old male patient with Marfan's syndrome and severe pectus excavatum who had severe mitral regurgitation and moderate aortic regurgitation with 52mm aortic root dilation. The operative field was adequately exposed through a midline sternal incision with two sternal retactors. The patient underwent Bentall operation and mitral valve replacement. The repair of pectus excavatum was performed after completion of CPB and the administration of protamin. Permanent internal stabilization achieved by overlapping of the ends of lower ribs and reinforced with sternal closure wire.

• Journal of Chest Surgery
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• v.32 no.10
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• pp.930-934
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• 1999

Background: The purpose of this study is to analyze the clinical results ad operative compatability by Ravitch methods with pectus excavatum. Material and Method: From 1984 to 1997, were performed Ravitch operations in 40 patients of pectus excavatum and analyzed the effects of correction and postoperative complication according to time of operation retrospectively. The group comprised 35 mem and women whose mean age was 8.9$\pm$7.9 years(between 2 to 35 years). All patients had corrected with Ravitch operation or its modified operation. Modified fixations were accomplished with K-wire in 15 patients and internal plate in 2 and the materials were removed 3 months after operation. The result of correction was estimated with the degree of changed distance between inner surface of sternal body and vertebral in 3 months after correction. Result: Postoperative complications were wound disruption in 14 patients. Estimated distances after correction ranged 0.4 cm to 4 cm. The acceptability for chest wall correction was high(6 excellent, 29 good in criteria of Humphreys). Conclusion: We concluded that the benefits of Ravitch operation were a high acceptability of patients and their family, and sufficient correction with no specific complications related operation.

• Korean Journal of Veterinary Research
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• v.41 no.3
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• pp.447-451
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• 2001

A 6-week-old female cocker spaniel, with a history of abasia astasia, was referred to the Department of Laboratory Animal Medicine, Medical Research Center, Yonsei University College of Medicine on February 23, 2000. The ribs inclined downwards with a sharp slope on both lateral sides of the thorax. The animal was diagnosed as pectus excavatum. She showed no signs of dyspnea, dyschezia, or dysuria. There was no heart murmur or sign of neural disease. For rehabilitation treatment, she was given physical exercise therapy 2 to 3 times a day by bending and stretching each articulation of the hind limbs and pressing the costochondral junction in and upward with both hands placed on each lateral side. After a month of therapy, she was able to stand up and walk. The therapy continued and resulted in the slight reformation of a round thoracic wall. The flattened rib cartilages grew more round by palpation and the thoracic cavity distended. Rehabilitation therapy yielded good results, enabling the subject to walk and run normally, as the thoracic cavity was distended by the rounded rib junction.

• Journal of Chest Surgery
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• v.31 no.6
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• pp.576-580
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• 1998

This study is to clarify the results of atrial septal defect(ASD) repair and mitral valve surgery through right anterolateral thoracotomy since 1989, and those of more generalized application of minimal invasive cardiac surgery since August 1997. We retrospectively analyzed the results of open heart surgery(OHS) through other than full sternotomy carried out until October 1997. There were 28 cases of OHS done through right anterolateral thoracotomy(17 cases of ASD, 4 cases of mitral valve repair, 6 cases of mitral valve replacement, and 1 redo mitral and tricuspid valve repalcement) which has demonstrated no surgical mortality or morbidity except only 1 case of reoperation for bleeding. During the period between August and October 1997, we performed near routine application of upper sternotomy or transverse sternotomy in aortic valve cases and routine application of minimal incision in cases with ASD and there was no evidence of early and late complications associated with this approach. We conclude that OHS with the use of minimal incisions is very safe, cosmetically excellent, and superior in terms of the amount of bleeding. The indication for minimal incision, therefore, should be extended afterwards.

• Journal of Chest Surgery
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• v.41 no.6
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• pp.803-806
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• 2008

The Nuss procedure has good cosmetic effects, but it could be cause of bleeding and organ injury during dissection of the anterior mediastinum. We have made an effort to overcome the defects of the traditional method through the anterior mediastinum, thus we developed a transilluminated introducer that made it safer and simpler to operate within a 1cm incision only. A total of 67 patients underwent the Nuss procedure using the transilluminated introducer. Thirty-six patients underwent the procedure with the transilluminated introducer only (age<4 years). Thirty-one patients had an additional thoracoscopy ($age{\geq}14\;years$). There were no major complications, such as massive bleeding or organ injury in the thoracic cavity during or after the Nuss procedure. Our findings demonstrated that the anterior mediastium could be dissected simply and safely by the use of a transilluminated introducer during the Nuss procedure without fatal major complications, such as bleeding and organ injury.

• Journal of Chest Surgery
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• v.25 no.6
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• pp.621-629
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• 1992

Thirteen sternocosal elevations for pectus excavatum were performed on twelve patients between Jan 1989 and Sep. 1991. Eleven among the twleve patients were male. The subjects ranged in age from 2 years to 20 years, with a mean age of 8.33 years[SD=4.80 years], Eleven patients were below 15 years. The early postoperative evaluation by Humphreys` criteria except keloid formation was excellent in all the patients. The lower vertebral index[LVI], configuration index[CI], and upper vertebral index[UVI] were measured on the lateral chest roentgenogram. The LVI and CI improved significantly from 0.31$\pm$0.06 and 1.14$\pm$0.06 preoperatively to 0.25$\pm$0.03 and 0.78$\pm$1.10 postoperatively. The degrees of depression, flatness, and asymmetry and funnel index were measured at the most deformed portion on the computed tomgram performed pre- and postoperatively. The degrees of depression and funnel index improved significantly from 3.32$\pm$0.73 and 5.77$\pm$1. 54 preoperatively to 1.85$\pm$0.14 and 2.96$\pm$0.43 postoperatively, There was no significant change in the degree of flatness however, Six postoperative morbidities occurred in five patients Three were superficial wound infection, two hemopneumothorax, and one reoeration, Reoperation was performed due to forward displacement of the distal sternum below the posterior sternotomy, The findings of this study suggest that the sternocostal elevation is an excellent primary method for the pectus excavatum of children and young adolescents.

• Journal of Chest Surgery
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• v.32 no.4
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• pp.399-403
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• 1999

Background: Funnel chest is one of the most common anomaly of chest wall, which is manifested by depression of sternum and costal cartilage. Popular operative methods were Ravitch operation and Wada operation. Material and Method: From 1983 to 1996, 21 cases of funnel chest were corrected surgically in the department of thoracic surgery, National Medical Center. Investigated age and sex distribution, combined anomaly,clinical symptom, degree of correction and complication, postoperative satisfaction. We used 2 different surgical methods, one was Wada & its variants(17 cases), the other was Ravitch and it variants(4 cases). Most of operative indications were cosmetic problems. Result: The pre-operative Welch index was 4.188, but this index decreased to 3.46 after the operations.(p=0.046) The degree of correction was higher in Wada & it variant operation than the modified Ravitch operation.(p=0.54) Their results were satisfactory in 20 patients, while unsatisfactory in 1 patient because of a k-wire fracture. There was no recurrence of chest wall depression or postoperative death during the OPD follow up period. Conclusion: We recommend Wada operation in symmetric and small degree of depressive chest wall deformity in preand post school age.