123 * THE MORPHOLOGY OF THE THORAX AND HEART IN PATIENTS WITH PECTUS EXCAVATUM, AND THE CHANGES AFTER SURGICAL CORRECTION

Objectives: Patients with pectus excavatum often suffer physical complaints. Improvement of symptoms after surgical correction has been reported. We investigated the morphology of the thorax and heart which was characteristic of the patients, and the changes following surgery to evaluate the cause of symptoms. Methods: From April 2006, we performed a surgical repair of the pectus excavatum in 146 patients. The mean age was 15.2 ± 9.0 years. Using the sterno-costal elevation procedure, we resected a section of the deformed costal cartilages and the lower tip of the sternum, and resutured all of the stumps. The secured ribs pulled the sternum bilaterally, and caused the sternum to rise anteriorly. We measured the morphology of the thorax and the heart using chest CT. Results: The preoperative length/breadth ratio of the thorax (outer horizontal diameter – diameter in midsubclavian line ratio) was 0.63 ± 0.04, increasing significantly to 0.69 ± 0.05 after surgery (P < 0.001). The cross-section did not change (270.5 ± 33.7 and 273 ± 32.0 cm2). The short/long axis ratio of the heart increased significantly from 0.61 ± 0.05 to 0.71 ± 0.04 (P < 0.001). The rate of change in the length/breadth ratio of the thorax and in the short/long axis ratio of the heart after surgery did not have correlation with age. Conclusion: Sterno-costal elevation increases the anterior-posterior diameter of the thorax, as well as corrects the depression of the sternum. Compression of the heart is relieved, restoring its spherical shape after surgery. These effects were seen in each of the age groups, and helped to alleviate physical complaints.