STERNAL ABNORMALITIES IN PATIENTS WITH CONGENITAL HEART DISEASE

¹ Junior Assistant Resident, Radiology, The Massachusetts General Hospital, Boston, Massachusetts.
² Picker Scholar in Radiologic Research, James Picker Foundation, NAS-NRC.

In a prospective study of 123 adolescent and young adult patients and 128 infant patients with congenital heart disease, we found an incidence of 62 per cent of complete mesosternal fusion in the older age group and 1.6 per cent among the infants. This represented an increased incidence of mesosternal fusion over normals. Females demonstrated more mesosternal fusion (80 per cent) than did males (51 per cent), and 95 per cent of cyanotic females had fused mesosterna. Manubriosternal fusion in our population (16 per cent) was increased above normals at all age groups. The incidence of pectus carinatum deformity (15 per cent) in our population was similar to the previous reports of this deformity in patients with CHD, but the finding of a higher incidence (26 per cent) of pectus carinatum deformity among cyanotic patients as compared with acyanotic patients (6.2 per cent) represented a new observation. No increased incidence of double manubrial centers was found among patients with CHD.

Our study supports the theory that early fusion of the sterna is acquired and not the result of primary nonsegmentation, but the factors leading to early sternal fusion in patients with CHD are still uncertain. Many proposals for the etiology of pectus carinatum deformity are presented, but our study does not differentiate among these.

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