Long-term results after correction of anterior chest wall deformities

Background. Surgical correction of pectus deformities was mainly performed for cosmetic and psychologic reasons but eventual cardiopulmonary symptoms improved. Whether this results from alterations in cardiopulmonary physiology is still controversial. Methods. In 25 years 662 patients underwent correction (390 for pectus excavatum-funnel chest, 235 for pectus carinatum-chicken chest, 37 for pectus arcuatum -pouter pigeon chest). Surgical correction was mainly performed for cosmetic and psychologic reasons. Sternochondroplasty was performed without prosthetic material. Results. Clinical results for funnel chest were satisfactory in 83.6% (excellent 44.1%, good 39.5%) and were always good for protrusion deformities if enough deformed cartilages were resected. In a retrospective study the pulmonary function tests performed on 152 patients with funnel chest before surgery and at longterm follow-up demonstrated an eventual increased restriction at follow-up, despite symptomatic improvement and increased anteroposterior chest diameter on the X-ray, but restricted anterior chest wall motion. In a prospective study the exercise cardiorespiratory function tests on 35 patients with funnel chest before and one year after operation suggested unchanged work performance, but an increased oxygen consumption and acidification due to a higher work of breathing after operation, caused by decreased chest wall compliance. Conclusions. The subjective physical improvement after operation cannot be explained by changes in static lung volumes or in cardiorespiratory function at exercise, but is due to other unexplained factors. Satisfactory subjective long-term results of most patients justify surgical correction. Both physical as well as psychologic and cosmetic factors may allow operative correction.