Congenital Chondrosternal Depression (Funnel Chest) Its Treatment by Phrenosternolysis and Chondrosternoplasty

Congenital deformities of the anterior chest wall which are believed by the author to be due to the contractions of a congenital abnormally developed diaphragm have been briefly discussed. Based upon this theory, a new nomenclature and classification have been suggested.

Infants with a congenital chondrosternal depression (funnel chest) have a mobile inspiratory retraction of the chondrosternal area and the epigastrium. This is due to the pull of the congenitally deficient tendinous anterior portion of the diaphragm on its attachment to the chondrogladiolar-xiphoid junction. To offset this mechanism thereby reducing this retraction, and prevent the fixed depression which would develop later, the author prescribes the operation, phrenosternolysis, as early as possible. A description of the operation as practiced by the author is given. Tabulated is a summary of five infants who were treated by phrenosternolysis with satisfactory results.

In childhood, the deformity becomes fixed and comparatively immobile. In the older group with this depression, definite cardiorespiratory symptoms and signs result because of the compression or rotation of the heart and great vessels. In these patients the cardiorespiratory symptoms as well as emotional disturbances have been severe enough and sufficiently incapacitating to warrant surgical correction. For such patients, the author employs an operation he has termed chondrosternoplasty, the details of which are described. Summaries of the case histories of six patients so treated are given. In all these patients the cosmetic result has been most satisfactory. All have been able to indulge in greater physical activity. The adult group are now performing arduous labor whereas before they could not work at any strenuous job. Attention is invited to the finding of a marked orthostatic pulse and blood pressure in this group.