• J A Haller, P M Colombani, C T Humphries, R G Azizkhan, and G M Loughlin.
• Division of Pediatric Surgery, Johns Hopkins Children's Center, Baltimore, Maryland 21287-3716, USA.
• Ann. Thorac. Surg. 1996 Jun 1; 61 (6): 1618-24; discussion 1625.

Background And MethodsSince 1990 we have evaluated 12 children and teenagers in whom severe cardiorespiratory symptoms have developed due to failure of chest wall growth after very extensive pectus excavatum operations (removal of five or more ribs) at very early ages (< 4 years).ResultsApparently these extensive procedures have removed or prevented growth center activity, which resulted in restriction of chest wall growth with marked limitation of ventilatory function. The forced vital capacity ranged from 30% to 50% of predicted and the forced expiratory volume in 1 second from 30% to 60%. All patients are symptomatic with mild exercise and cannot compete in running games. Our protocol for critical evaluation includes exercise pulmonary function studies and axial computed tomographic reconstruction.ConclusionsThis report is an alert to recognize such patients and also to recommend delay in operative repair in small children until at least 6 to 8 years of age. The younger the patient the more limited the chest wall resection for pectus excavatum should be. Five of these patients have had a chest cavity expansion operation with encouraging early results.

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