• Journal of Chest Surgery
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• v.25 no.3
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• pp.276-282
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• 1992

From Jan. 1981 to Dec. 1989 eleven cases of Funnel Chest, ten were males and one was female, were underwent an operation at the Department of Thoracic and Cardiovascular Surgery. Cheonbuk National University Hospital. The age of patients ranged from 3 to 29 years old. They all had symptoms of feeling inferiority about chest deformity. The degree of concavity on the funnel chest varied in extent, and the severity which was measured by water volume filled into it varied from 20 ml to 140 ml. Nine patients were corrected by Ravitch method and two patients were corrected by the Modified sternal turnover method. The Ravitch method was more effective in asymmetrical, severe depression deformity and in children. On the other hand the Modified sternal turnover method with preservation of vascular supply of repair was more simple and more effective in case of relatively less severe, wide symmetrical depression deformity of the chest and in case of associated with congenital or acquired heart disease and disease of the ascending aorta. This method has the advantage of maintaining chest wall stability in postoperative period.

• Journal of Chest Surgery
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• v.19 no.4
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• pp.707-714
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• 1986

Funnel chest is the most common deformity of the sternum. It is characterized by a funnel shaped depression of the sternum with sharp angulation and lengthening of the costal cartilages, with the result that the cartilages point posteriorly. We have experienced with eight cases of funnel chest for 2 years recently, and they were corrected by the method of Ravitch operation with or without Kirschner`s wire. The postoperative course was uneventful. And now we report these with literature review.

• Journal of Chest Surgery
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• v.16 no.1
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• pp.183-190
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• 1983

Pectus Excavatum is a congenital anomaly of the anterior chest wall with a sharp concave curvature of the body of the sternum, from above downward and from side to side, especially just before the junction of gladiolo-xiphoid. We have experienced 14 cases of Pectus Excavatum with several operative procedures, i.e., Ravitch operation in 1 case, Wada operation [Sternal turn-over} in 3 cases, Wada operation and K-wire splint in 5 cases, Modified Wada operation [Rectus Abdominis muscle pedicle attached sternal turn-over] in 5 cases. Nearly all patients developed flail chest treated with internal fixation, and necrotic chondritis was developed postoperatively and treated with excision and curettage in one case with Wada operation. Follow-up Vertebral Index showed 48% preoperatively and 33% postoperatively, average decrement of 15%. We report 14 cases of Pectus Excavatum and their operative treatments.

• Journal of Chest Surgery
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• v.30 no.12
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• pp.1247-1250
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• 1997

A 13-year-old boy presented with anterior chest wall depression and dyspnea on exertion(NYHA II). He underwent Ravitch operation for pectus excavatum 7 years ago. A preoperative echocardiographic study revealed secundum atrial septal defect. He had no other abnormality of laboratory test, except FVC and FEVI were decreased into 2.03 L(7 %) and 1.82 L(71 %). He underwent repair of secondary anterior chest wall deformity and secundum atrial septal defect. We used unique method, raising sternum at right angle to secure good operative field for open heart surgery. Acute respiratory insufficiency was developed on postoperative day 1. Mechanical ventilation was applied which could be weaned on postoperative day 6 and thereafter hospital course was uneventful without any other sequale. He was discharged on postoperative day 19.

• Journal of Chest Surgery
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• v.15 no.1
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• pp.21-26
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• 1982

Fourteen cases of funnel deformity, 11 were male and the others female, treated over a eleven-year period, are presented. The overall results with the methods described by the authors, Wada, Shannon, Adkins and Ravitch appear to be excellent. The symmetric depression was more common In children under the age of 12 years and asymmetric one Increased after the age of 12. Six cases of abnormal cardiac auscultatory findings revealed no consistent hemodynamic abnormalities. An 21-year-old female was associated with left lung agenesis and dextroversion of the heart, and a 6-year-old boy with congenital bronchogenic cyst who underwent right upper lobectomy. EKG changes associated with the anomaly were observed in all. Pulmonary function test showed the range from normal to moderate restriction which did not Improve in only one patient after operation, but the patient did not complain any restriction In activity. Some transient complications were developed which resulted in improvement.

• Journal of Chest Surgery
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• v.45 no.6
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• pp.418-420
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• 2012

Pectus excavatum is rare, but it is the most common type of sternal congenital disorder. There are many surgical methods to correct pectus excavatum such as the Ravitch method, Wada method, Silastic mold method, and the Nuss operation. We report a case of minimal invasive surgery for pectus excavatum using a polyvinyl alcohol sponge.

• Journal of Chest Surgery
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• v.20 no.1
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• pp.161-170
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• 1987

Fifty-nine cases of congenital chest wall defects experienced in the department of thoracic surgery of Seoul National University Hospital were analyzed and the relevant literatures were reviewed. They are 52 cases of funnel chest, 3 cases of pigeon breast, one case of superior sternal fissure, one case of costochondral incurvation, one case of Cantrell`s pentalogy, and one case of Poland`s syndrome. Funnel chest affected males more frequently than females by 44 to 8. All of the funnel deformities were corrected by Ravitch operation or its modification except one which was the first case of this series and was corrected by a sterno-turnover. Two cases required a mechanical ventilation for 3 days and 5 days respectively. Four minor complications which were two cases of skin wound infection and 2 cases of fluid accumulation were noted. Skin would infection was repaired by a secondary closure and fluid accumulation was treated by aspiration only. The result are all excellent without recurrence or reoperation. In 3 cases of pigeon breast, they were treated by subperichondrial resection of all of the involved costal cartilages and shortening their course with reefing sutures in the perichondrium with excellent result. The superior sternal fissure which was combined by a ventricular septal defect was treated by a simple wire closure with a good result. The costochondral incurvation was corrected by subperichondrial resection of deformed cartilages and a rib graft removed from the contralateral normal side. The Poland syndrome and the Cantrell`s pentalogy was already presented previously.

• Journal of Chest Surgery
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• v.11 no.3
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• pp.246-252
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• 1978

A three year and seven month old girl with moderate depression deformity of the sternum associated with a huge well defined homogenous hazy mass density of the upper half of the right hemithorax on plain chest x-ray had developed, exertionaI dyspnea (Figs1, 2 and 3). Correction of the funnel chest was carried out with modified Ravitch procedure and resection of the intrathoracic cystic mass was performed through an anterolateral thoracotomy incision in one stage operation satisfactorily (Figs. 7 and 8). On exploration, the mass, $15{\times}12{\times}10$cm in size, was connected to the bronchus at 1cm a bove the carina by a stalk (Fig. 4). The outer surface showed abundant vasculature. The specimen was filled with mucoid material; the inner surface was much trabeculated. glistening and smooth (Fig. 5 and 6). yficroscopically, the cyst was lined with simple or pseudostratified ciliated columnar epithelium. The cystic wall was composed of loose fibrous connective tissue, muscle layers, cartilages with some lymphocytic infiltration (Fig. 9). Isolated cases of funnel chest deformity and congenital bronchogenic cystic disease are not uncommon; however, the assocbtion of the two conditions is yery rare. Therefore. report and review of the literature was done.

• Journal of Chest Surgery
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• v.49 no.3
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• pp.214-217
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• 2016

Pectus arcuatum is a rare complex chest wall deformity. A 31-year-old female presented with a severely protruding upper sternum combined with a concave lower sternum. We planned a modified Ravitch-type operation. Through vertical mid-sternal incision, chondrectomies were performed from the second to fifth costal cartilages, saving the perichondrium. Horizontal osteotomy was performed in a wedge shape on the most protruding point, and followed by an additional partial osteotomy at the most concaved point. The harvested wedge-shape bone fragments were minced and re-implanted to the latter osteotomy site. The osteotomized sternum was fixed with multiple wirings. With chondrosternoplasty, a complex chest wall deformity can be corrected successfully.

• Journal of Chest Surgery
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• v.25 no.12
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• pp.1416-1421
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• 1992

There are many objective indices of operative outcome of funnel chest, but there has been only a few report about the postoperative change of these indices and which is best correlated with subjective outcome. From January 1989 to December 1991, 74 patients with funnel chest underwent Ravitch operation and radiologic evaluation was performed on the twenty patients whose operative outcome were satisfactory by Humphreys` criteria and postoperative chest X-ray were available. Variable radiologic chest idices such as deformity grade [DG], lower vertebral index [LVI], upper vertebral index [UVI] and configuration index [CI] were measured preoperatively and 1, 6, 12 and 18 months pos-toperatively. The mean value of preoperative DG, LVI, UVI and CI were 5.32, 0.3, 0.26 and 1.01 respectively, and postoperative chages were as follows; DG; 3.13, 3.66, 3, 72, 4.0, LVI: 0.22, 0, 24, 0.25, 0.25 UVI; 0.27, 0.27, 0.27, 0.27 CI; 0.69, 0.77, 0.76, 0.79. The increments of CI were within the 90 percent confidence limit of normogram in most cases, but it was not true for LVI and UVI. And the differences between the observed and expected values of CI did not change significantly through the postoperative periods, which was not the case in LVI. We concluded from these results that 1] DG, LVI and CI were increased slowly during the postoperative follow up periods but the increments of CI were usually within the normal limits and so 2] CI can be used as a objective index of satisfactory outcome.