Læknablaðið - 15.10.1993, Blaðsíða 19

LÆKNABLAÐIÐ
31!
skyndileg hjartsláttarköst og óreglulegan
hjartslátt, sem kom jafnvel án sérstakrar
áreynslu. Þessi köst ágerðust og tók sjúklingur
einnig að mæðast og fá hjartsvæðisverk, sem
leiddi út í vinstri handlegg. Þetta gat komið
bæði við áreynslu og í hvíld. Sjúklingur var
lagður inn á hjartadeild Landspítalans til
rannsóknar. Þar leiddu rannsóknir eftirfarandi
í ljós: Hjartarit sýndi öxulsnúning og hægra
greinrof, það gaf jafnframt grun um ofvöxt
á hægri slegli. Hjartaþræðing sýndi skert
hjartaútfall en engin merki um vefrænan
hjartasjúkdóm. Lungnarannsókn sýndi mikla
skerðingu og teppu og léleg blóðgös. Röntgen-
mynd af brjóstholi leiddi í ljós að fjarlægð
á milli afturbrúnar bringubeins og hryggsúlu
var 3,5 centimetrar. Samkvæmt læknisráði
var sjúklingi gefið tbl. Inderal 20 mgx3, en
einkenni skánuðu ekki og aðgerð var gerð.
Sjúklingi heilsaðist vel eftir aðgerðina að öðru
leyti en því að hann fékk lítilsháttar sermigúl
(seroma) í sárið en það greri þó fljótt og
án frekari aukakvilla. Lungnarannsókn eftir
aðgerð sýndi eðlileg gildi og hjartarit varð
einnig eðlilegt. Hjartaþræðing var ekki gerð
eftir aðgerð. Röntgenmynd af brjóstholi sýndi
að fjarlægð milli afturbrúnar bringubeins og
hryggsúlu var nú 9 centimetrar. Sjúklingur
náði fullri heilsu og lyfjagjöf var hætt.
Myndir 11 og 12 sýna ljósmynd og röntgen-
mynd af bringu sjúklings fyrir aðgerð en myndir
13 og 14 eru teknar einu ári eftir aðgerð.
SUMMARY
Deformity of the thorax is considered a relatively
common deformity of wich funnel chest is the most
common. The incidence in the general population
has been reported 7.9/1000 based on examinations
of 15000 individuals in London.
During the period from March 1963 to January
1991, there were 61 procedures performed for
correction of funnel chest at the Department
of Thoracic Surgery, University Hospital,
Landspítalinn, Reykjavík, Iceland. The patients
ranged from 4 to 36 years of age, 45 males and
16 females . Fifty three were considered to have
severe deformity and 8 less severe.
All the procedures for funnel chest were performed
in the same way after 1970. Transverse or
longitudinal skin incisions were made over the
sternum, the depressed costal cartilages on both
sides were resected subperichondrially, transverse
sternal osteotomi was done above the depressed
part and the sternum lifted anteriorly and fixed with
an iron rod driven through the sternum. The ends
of the rod were sitting on the ribs on both sides
and fixed with a wire to a rib at one end but no
fixation was at the other end, thus giving the rod
opportunity to move with breathing and exertion.
The rod was usually removed after approximately
12 months when the thorax was stable.
The cosmetic results were considered good or fair
in 54 cases but unsatisfactory in six and in one
case informations were missing from the medical
record. Spirometry was performed in 29 cases and
showed minor deviation in pulmonary function in
13 but was grossly abnormal in one. E.C.G. was
performed in 53 cases with minor abnormality
in 14 but markedly abnormal in one. Heart
catheterizations were done in 2 cases one was
normal and the other abnormal. It was the same
patient who had severe symtoms of puimomary
and cardiac dysfunction before operation, but he
became completely asymtomatic postoperatively.
There was no mortality or severe complications.
There were six infections but those and other minor
complications could be treated easily.
In conclusion, we consider that the main indication
for surgery because of funnel chest is cosmetic
and our view is to be conservative in our
recommendations for repair.
HEIMILDIR
1. Ochsner JL, Oschner A. Funnel Chest
(Chonechondrostemon). Surg Clin North Am 1966;
46: 1493-500.
2. Haller JA, Peters GN, White JJ. Surgical management
of Funnel Chest (Pectus Excavatum). Surg Clin North
Am 1970; 50: 929-34.
3. Clark JG, Grenville-Mathers R. Pectus excavatum Br
Dis Chest 1962; 56: 202-5.
4. Ravitch MM. The operative treatment of pectus
excavatum. Ann Surg 1949; 129: 429-44.
5. Ravitch MM. Techhnical problems in operative
correction of Pectus Excavatum. Ann Surg 1965; 162:
29-33.
6. Harold C, Urschel H, Byrd S, Sethi SM, Razzuk MA.
Poland’s syndrorne: Improved surgical management.
Ann Thorac Surg 1984; 37: 204-11.
7. Shamberger RC, Welch KJ. Surgical Correction of
Pectus Carinatum. Pediatr Surg 1987; 22: 48-53.
8. Weg JG, Krumholz RA, Harkleroad LE. Pulmonary
Dysfunction in Pectus Excavatum. Am Rev Respir
Dis 1967; 96: 937-45.
9. Cahill JL, Lees GM, Robertson HT. A summary of
preoperative cardiorespiratory performance in patients
undergoing Pectus Excavatum and Carinatum repair.
Pediatr Surg 1984; 19: 430-2.
10. Beiser GD, Epstein SE, Stampfer M, Goldstein
RE, Noland SP, Levitsky S. Impairment of cardiac
function in patients with Pectus Excavatum with
improvement after operative correction. N Engl Med
J 1972; 287: 267-72.
11. Hawkins JA, Ehrenhaft JL, Doty DB. Repair of
Pectus Excavatum by Stemal eversion. Ann Thorac
Surg 1984; 38: 368-73.