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    Pectus Excavatum

    Pectus excavatum is an abnormal inward curve to the breastbone caused by an overgrowth of the connective tissue that joins the ribs to the breastbone. This overgrowth causes the sternum to malform inward giving the chest a caved-in appearance.

    Pectus excavatum occurs in one in 400 births and is more common in boys than girls (3:1). It can be noticeable at birth but becomes more prominent during times of rapid growth, such as puberty. Pectus excavatum may occur as the only abnormality, or together with other syndromes.

    Symptoms

    There are varying degrees of pectus excavatum, ranging from mild to severe. Symptoms are often not present in mild cases while more severe cases can create extra pressure on the heart and lungs – leading to more serious health problems like shortness of breath and limited physical activity. The visual appearance of a chest deformity can sometimes contribute to self-esteem and body image difficulties as well.

    Diagnosis

    Pectus excavatum is diagnosed by a thorough health history review and physical exam. CT scans are an essential part of the diagnosis as they reveal any compression or displacement of the heart and provide the Haller index. The Haller index reveals the ratio between the chest measurement from one side of the ribcage to the other, and the measurement from the spinal cord to the breastbone. The radio helps the doctor determine the level of severity of the sunken chest. 

    The doctor may conduct additional testing if a child has symptoms of poor heart or lung function.

    Treatment

    In the past, children born with chest wall malformations often underwent debilitating operations, but recent medical advances allow surgeons to provide less invasive treatments. CHoR's chest wall program  offers expertise in these cutting-edge approaches to chest wall correction.

    Dr. Thomas Yeh, a senior pediatric cardiothoracic surgerone, has performed hundreds of minimally invasive surgeries to correct chest wall defects.

    Nuss Procedure

    The Nuss procedure is a minimally invasive surgical procedure that corrects the sunken appearance of the chest.  This minimally invasive surgery reduces operating time, minimizes blood loss and enables a quicker recovery than more invasive approaches. Most children return to school just a few weeks after the Nuss procedure and resume normal activity after about a month.

    The Nuss procedure involves two small incisions made on each side of the chest to allow the surgeon to insert the stabilizing bar. A third incision is made in which a small camera is inserted that allows the surgeon to see inside the chest wall. The stabilizing bar is placed under the breastbone to correct the depression in the chest. The bar is typically removed two to four years after the procedure during an outpatient surgery under general anesthesia. 

    Activity Restrictions

    The following physical activities are not permitted while the metal bar is in the chest:

    • Football
    • Hang gliding
    • High diving
    • Kickboxing
    • Martial arts
    • Pole vaulting
    • Riding a motorcycle
    • Rifle/shot gun shooting
    • Skateboarding
    • Skydiving
    • Trampoline jumping
    • Water skiing

    The following physical activities are permitted while the metal bar is in the chest:

    • Archery
    • Baseball
    • Basketball
    • Golf
    • Soccer
    • Softball
    • Tennis
    • Track and field
    • Weight lifting
    • Wrestling

    Appointments and Location

    (804) 828-CHOR (2467)

    Nelson Clinic, 1st Floor

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