Embargoed for Release On or After March 1, 2000
Roxanne Yamaguchi Moster
(310) 794-0777
([email protected])
CHILDREN BORN WITH CHEST WALL DEFORMITIES SEE MARKED HEALTH IMPROVEMENT WHEN CORRECTIVE SURGERY IS PERFORMED SAY UCLA SURGEONS
For children born with chest wall deformities, a new UCLA study shows that surgical intervention can improve their long-term health, with excellent physical and cosmetic results and a low complication rate.
Approximately one in every 600 babies born has an abnormal overgrowth of cartilage between the ribs and sternum that pushes the sternum inward (pectus excavatum) or outward (pectus carinatum) causing a sunken-chest or pigeon-chest result. The condition affects boys six times more frequently than girls.
But the recognition of symptoms and the recommendation for surgical correction have frequently been overlooked by members of the medical community say UCLA surgeons.
"Chest wall deformities are relatively common and often produce undesirable physical consequences for a child ranging from heart and respiratory symptoms to exercise intolerance," said Dr. Eric W. Fonkalsrud, UCLA pediatric surgeon and the study's principal investigator. "However, symptoms are recognized infrequently during early childhood."
UCLA doctors say that well-meaning family doctors and pediatricians advise most parents that the child will outgrow the deformity, that it will not affect heart or lung performance, is primarily a cosmetic problem, and that surgical repair is dangerous, minimally effective and unnecessary.
UCLA researchers emphasize that the condition almost always worsens as the child matures. It even affects what activities children engage in. Many adolescent patients chose sedentary activities, such as working with computers, rather than athletics.
UCLA reviewed the surgical outcomes of 375 patients with pectus excavatum chest deformities at the UCLA Mattel Children's Hospital during a 30-year period. The deformity was evident during the first few months of life in 88 percent of patients and a family history was present in 42 percent of patients.
The most common complaint for young patients was related to the unattractive physical appearance of the deformity. Many are unwilling to go without a shirt while swimming or to participate in other athletic or social activities.
The sunken chest condition usually displaces the heart into the left chest and limits full lung expansion. Functional heart murmurs were present in 24 percent of patients.
Mild to severe exercise limitation with decreased stamina and endurance and the inability to keep up with peers in strenuous athletic activities was reported by 67 percent of patients. Many had been able to participate in competitive athletic activities during early adolescence but then found it progressively more difficult to keep up with peers.
Frequent respiratory infections were experienced by 32 percent of patients; 7 percent had asthmatic symptoms, which were often severe after exercise.
"The operation is technically easiest to perform and the recovery is faster in pre-adolescent children," said Fonkalsrud. "However, almost half of all patients undergoing the operation are teenagers. During the past few years, several adults have successfully undergone the repair. With an average follow-up of over 12 years with more than 375 patients, more than 96 percent have considered the result very good to excellent."
Each of the 251 patients who experienced limited stamina and endurance with mild exercise experienced marked improvement within four months after surgery and most could participate in vigorous exercise.
Of the 120 patients with preoperative respiratory problems, 115 had a decrease in frequency and severity of pulmonary infections after repair. Of the 26 patients with asthmatic symptoms, 24 showed improvement after surgery.
Each of the 48 patients with chest pain reported considerable improvement within three months.
Almost all patients showed a shifting of the heart from the left chest to a normal position on chest radiographs within a few weeks. And functional heart murmurs were no longer audible in 74 of the 90 patients.
"The surgical technique for repair has improved greatly, complications are uncommon and pain is remarkably mild following the operation," said Fonkulsrud. "It's thrilling to see our patients gain new abilities. We had one 15-year-old girl who always wanted to sing professionally. Several months after her surgery, she sent me an audiotape of her singing a beautiful collection of arias."
Surgeons remove three-to-five abnormal cartilages on each side of the lower chest while carefully preserving the perichondrial sheath around the cartilage. The sternum is elevated to the desired position and is supported by a thin metal bar, which is attached to a rib on each side. The chest forms new cartilage and become solid in the normal position within six weeks. Hospital stays averaged three days and most patients returned to school or work within two weeks. The metal bar is removed on an outpatient basis within six months.
After recovery, patients were able to participate in vigorous physical activities, including body contact sports.
"The patients and families are the most gratified, by far, of any group of patients that we have operated on during the past 30 years," said Fonkasrud.
In addition to Fonkalsrud, the other study authors included Dr. James C.Y. Dunn and Dr. James B. Atkinson, all from the Mattel Children's Hospital at UCLA's Department of Surgery.
-UCLA-
For a copy of the research paper including before and after photos, to interview one of the UCLA surgeons and to interview patients, who have gone through the procedure, contact Roxanne Yamaguchi Moster, UCLA Health Sciences Communications at (310) 794-0777.
Roxanne Yamaguchi Moster
Assistant Director, Media Relations UCLA Health Sciences Communications
924 Westwood Blvd., #350
Los Angeles, CA 90095
(310) 794-0777 phone
(310) 794-2259 fax
[email protected]
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