Division of Cardiovascular and Thoracic Surgery, Mayo Clinic Hospital, Phoenix, Arizona; Department of Surgery, Phoenix Children's Hospital, Phoenix, Arizona.
Division of Cardiovascular and Thoracic Surgery, Mayo Clinic Hospital, Phoenix, Arizona; Department of Surgery, Phoenix Children's Hospital, Phoenix, Arizona.
Ann Thorac Surg. 2014 May;97(5):1764-70. doi: 10.1016/j.athoracsur.2014.01.030. Epub 2014 Mar 13.
In young children, acquired thoracic dystrophy (ATD) is associated with extensive resection of cartilage, often during open pectus excavatum (PE) repair. Progressive dyspnea or exercise intolerance may develop in these patients secondary to cardiac compression or restrictive pulmonary function. Surgical treatment of ATD by attempting to increase the overall thoracic volume has been controversial. We describe our experience with adults presenting for surgical correction of ATD.
A retrospective medical record review was performed for all patients with ATD presenting for surgical evaluation from December 2010 through February 2013.
Ten adult male patients were evaluated for treatment of ATD after an open Ravitch procedure for PE. Nine patients, whose mean age was 34 years (range, 21-42 years), elected to proceed with surgical treatment. The mean age of the initial repair was 3.7 years. Extensive reconstruction, chest wall expansion, and placement of stainless steel support bars and titanium plating were performed in all patients. Eight patients had minor complications, and major complications occurred in 3 patients. Respiratory failure with prolonged ventilator support occurred in 3 patients. There were no reoperations or deaths. At mean follow-up of 16 months (range, 6-31 months), all patients subjectively reported improvement in their ability to exercise and in their symptoms, including dyspnea with exertion.
ATD may be associated with early childhood Ravitch repair. Adults may present with disabling symptoms related to cardiac compression and restrictive pulmonary function. Reconstruction with sternal elevation and expansion of the anterior chest subjectively improves symptoms.
在幼儿中，获得性胸壁畸形（ATD）与广泛切除软骨有关，通常在开放性漏斗胸（PE）修复期间进行。这些患者可能会因心脏受压或限制性肺功能而出现进行性呼吸困难或运动不耐受。通过尝试增加整体胸廓体积来治疗 ATD 的手术治疗一直存在争议。我们描述了我们在接受手术矫正 ATD 的成年人中的经验。
对 2010 年 12 月至 2013 年 2 月期间因 ATD 接受手术评估的所有患者进行了回顾性病历审查。
10 名成年男性患者因 PE 的开放式 Ravitch 手术后出现 ATD 接受治疗评估。9 名患者（平均年龄 34 岁，范围 21-42 岁）选择接受手术治疗。初次修复的平均年龄为 3.7 岁。所有患者均进行了广泛重建、胸廓扩张以及不锈钢支撑棒和钛板的放置。8 例患者出现轻微并发症，3 例患者出现严重并发症。3 例患者发生呼吸衰竭，需要长时间呼吸机支持。无再次手术或死亡病例。平均随访 16 个月（范围 6-31 个月），所有患者均主观报告运动能力和症状改善，包括活动时呼吸困难。
ATD 可能与儿童早期 Ravitch 修复有关。成年人可能会出现与心脏受压和限制性肺功能相关的致残症状。胸骨抬高和前胸扩张重建可主观改善症状。
