A Pilot Study of a Sternal Closure Technique to Prevent Postoperative Pectus Carinatum in Congenital Heart Surgery Pediatric Patients
Teerawoot Jantarawan MD*, Somchai Sriyoschati MD*, Thaworn Subtaweesin MD*, Punnarerk Thongcharoen MD*, Pansak Laksanabunsong MD*, Kriangkrai Tantiwongkosri MD*
Affiliation : * Division of Cardiothoracic Surgery, Department of Surgery, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand
Background : Pectus carinatum has the psychological impact of the body image and quality of life of patients. The authors
have observed that several pediatric patients with previously normal chest wall contour undergoing open heart surgery
developed acquired/iatrogenic postoperative pectus carinatum.
Objective : The aims of the study were (1) to determine the incidence of postoperative pectus carinatum, and (2) to compare
the incidence of postoperative pectus carinatum in pediatric patients undergoing open heart surgery using conventional
parallel sternal closure (PSC) versus convergent sternal closure (CSC) technique.
Material and Method: The authors prospectively enrolled 52 pediatric patients who underwent open heart surgery. Twelve
patients were excluded because of secondary/delay sternal closure (n = 2), previous sternotomy (n = 6), and prior chest wall
deformity (n = 4). The 40 patients were randomized into two groups: 20 in PSC and 20 in CSC group. All patients were
followed-up at 6 months postoperatively to determine the occurrence of postoperative pectus carinatum.
Results : Of 40 (1.6+1.2 years; 55% were female) patients, post-operative pectus carinatum was present in 11 patients (28%).
At 6-month follow-up, post-operative pectus carinatum was more prevalent in patients using PSC technique (n = 10) than
those using CSC (n = 1) technique (50% vs. 5%; RR = 10 [95% CI = 1.41-70.99], p<0.001.
Conclusion : (1) The incidence of postoperative pectus carinatum was about one-fourth (28%) of pediatric patients undergoing
open heart surgery. (2) CSC technique reduced postoperative pectus carinatum compared with PSC technique in those
patients. (3) The authors suggest using convergent sternal closure technique in pediatric cardiac surgery to prevent the
postoperative pectus carinatum.
Keywords : Pectuscarinatum after cardiac surgery
