Impact of Surgical Treatments of Thoracic Deformation on Cardiopulmonary Functions
Condition: Pectus Excavatum; Pectus Carinatum
MeSH terms: Funnel Chest; Pectus Carinatum
Study type: Interventional

Summary: 
      Pectus excavatum or carinatum are the most common congenital deformations of the ventral
      thoracic wall. Several different surgical methods with different techniques to correct these
      deformations have been described.

      Some clinicians recommend a correction of the deformation to improve the cardiopulmonary
      efficiency. Other think that the correction has a more an aesthetic than a physiological
      benefit.

      The aim of our prospective study is to evaluate whether patients with PE or PC are suffering
      preoperatively from a cardiopulmonary limitation at rest and under physical stress and if
      there is a change of cardiopulmonary function after the surgical correction.
    

Detailed description: 
      Pectus excavatum (PE) and pectus carinatum (PC) are the most common anterior chest wall
      deformities. Pectus excavatum, also known as funnel chest, is characterised by a deep
      depression usually involving the lower one-half to two-thirds of the sternum. PE is the most
      common congenital chest deformity and has a reported incidence of between 1:1000 and 8:1000
      live births, with a male-to-female ratio of 3:1. Pectus carinatum, or pigeon breast, refers
      to protrusion of the sternum and is approximately seven times less frequent than PE,
      affecting 1:1000 to 1:10,000 live births. More than 26% have familial occurrence. The
      anatomic deformity is believed by many to be caused by a disproportionate growth of the
      costal cartilages as compared with the remainder of the bony thoracic skeleton, which exerts
      pressure on the sternum to cause depression (PE) and protrusion (PC). Although the majority
      of patients with PE are recognized during the first year of life, the depression usually
      becomes much more severe during childhood and adolescence; PC usually manifests itself at the
      time of a growth spurt in the early teenage years.

      The deformities frequently present not only as an aesthetic disturbance, but also in
      association with mild limitation of activity, obstructive pulmonary mechanics, slight
      dyspnea, asthma, palpitations and abnormal cardiac physiology. Symptoms in PC patients remain
      often vague. PC patients usually complain more about the appearance of their chest rather
      than any functional difficulties. Chest wall deformities cause great social timidity, a sense
      of shame and often a feeling of limited self-worth and inferiority, depressive mood and
      inadequate social behaviour due to their disturbed body perception.

      The results the investigators want to achieve with postoperative PFTs will demonstrate an
      improvement in total lung capacity and improved exercise performance and will show that both
      the restricted cardiac stroke volume and the increased work of breathing that have been
      described in PE patients can be ameliorated by operative intervention. These results will
      also contribute establish the criteria for the indication for surgery. The significant
      quality-of-life improvements perceived in psychosocial and physical functioning will
      encourage physicians to approach PE repair in the same manner as physicians do treatment of
      other deformities that have a deleterious impact on the psychological and physical well-being
      of the individual. Systematic evaluation of body image should become a diagnostic standard in
      the assessment of patients presenting themselves for correction of thoracic wall deformities.
    

Intervention name(s): Surgery
Intervention type(s): Procedure
Intervention description(s): Patients suffering from Pectus excavatum Pectus carinatum will be treated surgically according to normal procedures
Intervention model: Single Group Assignment
Masking: None (Open Label)
Primary purpose: Treatment