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Ann Thorac Surg 2002;74:2226
© 2002 The Society of Thoracic Surgeons

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Correspondence

Reply

^a Division of Plastic and Reconstructive Surgery, Department of Surgery, American University of Beirut Medical Center, PO Box 11-0236, Riad El Solh, Beirut 1107 2020, Lebanon

To the Editor:

I read with great appreciation the comments of Dr Norberg addressing our article [1]. These comments come from an expert group that described early surgical intervention in the Journal of Pediatric Surgery [2]. Dr Norberg now provides long follow-up on a female patient, who was saved by utilizing a methacrylate prosthesis to maintain an expanded mid sternal position. Their procedure required multiple surgical interventions and risked the possibility of infection commensurate to all synthetic material.

The perseverance using progressive interventions to expand the chest was empirical and critical to survival of the patient and provides us with adult physical and mental evaluation of such patients. They concluded that when the skeletal limitation was eliminated, lung organ growth occurs. Follow-up x-rays revealed that, although rib motility remains limited, the improvement in thoracic cage dimensions allows thoracic motion to meet respiratory demands. In other words, no matter what type of expansion is provided to these patients, we are not really offering cure but a remedy which still does not allow rib growth and motility.

Still, continued body growth increases pulmonary demand, which required multiple replacements of the prosthesis. This is one of the reasons why we thought that a dynamic solution, which allows continued expansion of the chest wall as the patient grows, is needed. The late result of these experts shows that these patients could be weaned off long-term ventilation and although somewhat physically limited, their intellectual life was more limited by phalangeal deformities than the thoracic limitation.

References

1. Kaddoura I.L., Obeid M.Y., Mroueh S.M., Nasser A.A. Dynamic thoracoplasty for asphyxiating thoracic dystrophy. Ann Thorac Surg 2001;72:1755-1758.[Abstract/Free Full Text]
2. Todd D.W., Tinguely S.J., Norberg W.J. A thoracic expansion technique for Jeune’s asphyxiating thoracic dystrophy. J Pediatr Surg 1986;21:161-163.[Medline]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Mounir Y. Obeid Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Kaddoura, I. L. Articles by Nasser, A. A. Search for Related Content PubMed Articles by Kaddoura, I. L. Articles by Nasser, A. A. Related Collections Chest wall