Pectus excavatum is a deformity of the front of the chest, where the chest has a sunken or “caved-in” appearance. This is a genetic abnormality that a person is born with that develops over time.
It is thought to be caused by abnormal growth of the cartilages on either side of the sternum, causing the sternum to begin to compress the heart, which lies underneath. Occasionally, the lower ribs may protrude or “flare”. The defect can be symmetric or asymmetric.
Most patients are males, but females can also be affected. Many patients may have a relative with a chest wall deformity as well. Pectus excavatum may appear when a child is a baby, but shows most often during the pre-teen and teenage years. The defect can worsen as the child grows.
Although some patients have no symptoms, most complain of shortness of breath and chest pain during exercise, but not at rest. As the deformity worsens, the symptoms usually worsen as well. Many patients with pectus excavatum say that they cannot keep up with their peers, or that they get tired much earlier than before the deformity was present.
Patients may feel depressed or have anxiety issues. They might be embarrassed to go to the pool or beach with their friends or remove their shirt in front of people. Some patients may become loners and refuse to socialize.
Determining a Diagnosis
Patients and families who are concerned about a chest wall abnormality should make an appointment with one of our pediatric surgeons who specializes in surgical and non-surgical treatment of chest wall abnormalities.
During the first appointment a complete history and physical exam will be performed. Additional testing such as a chest CT scan and pulmonary function tests may also be completed. A chest CT scan helps determine the severity of the deformity through a measurement called the Haller Index. Patients are also tested for any metal allergies as both surgical and non-surgical treatments involve metal parts touching the skin.
Treatment
Based on the patient’s physical exam and test results, the surgeon may advise that an operation is the best course of action. Surgeons at Texas Children’s generally perform a minimally invasive operation called the Nuss procedure to correct Pectus Excavatum. During this operation, a curved stainless steel bar is inserted in the chest through small incisions on either side, and is guided between the sternum and the heart under direct visualization with a camera through a small incision just below the sternum in the chest.
About the Surgery
The operation takes 1-2 hours for most patients. Occasionally, more than one bar will be inserted if the chest is not very flexible or if the entire sternum is depressed. The majority of patients require one bar. Special techniques are used to stabilize the bar to reduce the chance of it moving inside the chest after the procedure.
Pain control is important after a surgery like the Nuss Procedure. All patients discuss the type of pain control they will receive with the Anesthesiology Pain Management Service. Most of the pain medicine will be given through an IV or an epidural catheter after surgery. Patients are eventually transitioned to oral medications before going home.
Most patients will spend five to seven days in the hospital depending on when they can transition to oral pain medications. Patients will transition off oral medications at home over two to six weeks. Once off all pain medicines, they may slowly resume normal activities. Even with the bar (or bars) in place, patients can participate in all contact sports once they have fully recovered.
The bar is left in place for about three years. The operation to remove the bar is usually done on an outpatient basis, and the patient is generally sent home on the day of surgery. Recurrence of the Pectus Excavatum after the bar is removed is very rare.
Schedule a Consultation
All patients at Texas Children’s are treated in an individualized and family-centered manner. Our specialists provide cutting-edge treatment to achieve the best outcomes. Schedule your appointment by calling 832-822-3135.
