Unoperated funnel chest in middle and advanced age: Evaluation of indications for operation

Abstract

When the results of our examinations are summarized the following conclusions were reached: (1) Incidence and nature of complaints do not correlate with either the degree of funnel chest or with the results of cardiopulmonary examination. (2) individuals of athletic habitus even with a deep funnel demonstrate the fewest complaints and rarely have any cardiopulmonary alteration. (3) The highest incidence of symptoms is found in individuals of asthenic habitus with “flat” in addition to funnel chest who frequently show loss or reversal of thoracic spine kyphosis. (4) In no instance did complaints or objective alterations interfere with functional capacity to such a degree as to cause disability. There was no indication for operative therapy or cardiac treatment in any case. (5) The review of 12,000 autopsy protocols of the Pathological Institute, University of Hamburg, for the last 10 years failed to reveal a single case of funnel chest as sole or contributing cause of death. These results suggest that the indication for operative treatment of funnel chest as prophylaxis against possible cardiopulmonary complications later in life is at least debatable. Since psychic stress due to the malformation subsides beyond the age of 18–20 years the cosmetic indication must be regarded with great caution as well. Without doubt there remains a small number of individuals with marked complaints and signs of incapacity. These, however, do not have objective findings on routine cardiac and pulmonary examination. Perhaps cardiac catheterization with pressure determinations will determine the cause of symptoms in these cases. Our observations indicate that objective evidence for surgical correction of funnel chest seldom exists. We do not agree with the policy of routine surgical intervention even for minor degrees of funnel chest as recommended by some. Psychologic indications may well exist but must be carefully evaluation. When the results of our examinations are summarized the following conclusions were reached: (1) Incidence and nature of complaints do not correlate with either the degree of funnel chest or with the results of cardiopulmonary examination. (2) individuals of athletic habitus even with a deep funnel demonstrate the fewest complaints and rarely have any cardiopulmonary alteration. (3) The highest incidence of symptoms is found in individuals of asthenic habitus with “flat” in addition to funnel chest who frequently show loss or reversal of thoracic spine kyphosis. (4) In no instance did complaints or objective alterations interfere with functional capacity to such a degree as to cause disability. There was no indication for operative therapy or cardiac treatment in any case. (5) The review of 12,000 autopsy protocols of the Pathological Institute, University of Hamburg, for the last 10 years failed to reveal a single case of funnel chest as sole or contributing cause of death. These results suggest that the indication for operative treatment of funnel chest as prophylaxis against possible cardiopulmonary complications later in life is at least debatable. Since psychic stress due to the malformation subsides beyond the age of 18–20 years the cosmetic indication must be regarded with great caution as well. Without doubt there remains a small number of individuals with marked complaints and signs of incapacity. These, however, do not have objective findings on routine cardiac and pulmonary examination. Perhaps cardiac catheterization with pressure determinations will determine the cause of symptoms in these cases. Our observations indicate that objective evidence for surgical correction of funnel chest seldom exists. We do not agree with the policy of routine surgical intervention even for minor degrees of funnel chest as recommended by some. Psychologic indications may well exist but must be carefully evaluation.