title: Pectus excavatum repair using a costal cartilage graft for patients with tracheobronchomalacia.
abstract: BACKGROUND
  Pectus excavatum is sometimes associated with tracheobronchomalacia, which usually manifests left mediastinal shift, atelectasis of the left lung, and recurrent pulmonary infection. Standard repair of pectus excavatum alone usually failed to improve symptoms.
  
  
  METHODS
  Pexis of the great vessels and pericardium combined with the support of the lower sternum, using a contralateral costal cartilage graft following the standard Ravitch's repair of pectus excavatum, has been used in 6 children during the past 5 years. In addition to respiratory symptoms, diagnosis of tracheobronchomalacia was made by bronchoscopy using an ultrathin fiberscope.
  
  
  RESULTS
  Using the described operative technique, an excellent cosmetic and functional result was obtained in 5 of 6 children. However, atelectasis of the left lower lobe and the narrowing of the left mainstem bronchus continued postoperatively in one patient, which required the insertion of the Palmaz stent in the left mainstem bronchus.
  
  
  CONCLUSIONS
  This technique may help improve tracheobronchomalacia in patients with pectus excavatum and should be tried before the insertion of an internal stent.
authors.affiliation: Department of Pediatric Surgery, Osaka University Medical School, 2-2 Yamadaoka, Suita, Osaka 565-0871, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Kamata
authors.forename: N
authors.initials: N
authors.lastname: Usui
authors.forename: T
authors.initials: T
authors.lastname: Sawai
authors.forename: Y
authors.initials: Y
authors.lastname: Tazuke
authors.forename: K
authors.initials: K
authors.lastname: Nose
authors.forename: H
authors.initials: H
authors.lastname: Kawahara
authors.forename: A
authors.initials: A
authors.lastname: Okada
mesh_terms: D002356:Cartilage / Q000637:transplantation*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005660:Funnel Chest / Q000601:surgery*; D006801:Humans; D008297:Male; D012272:Ribs; D014133:Tracheal Diseases / Q000150:complications*