Health Library

Pectus Excavatum

What Are The Symptoms of Pectus Excavatum?

Although some children have no symptoms, symptoms usually vary with the severity of the condition. Younger children typically have fewer symptoms than older children.

• Children with less severe defects often have mild breathing problems.
• Children with moderate to severe pectus deformities often have trouble breathing when exercising or playing sports. They may not be able to exercise or play very long because they have reduced lung and/or heart function. Lung capacity is decreased and the filling capacity of the heart chambers is lessened because the sternum (breastbone) is pushing down on them. These symptoms can be quite severe at times and may limit the child's activity level.
• Growing teens may also have chest pain in the area of rib cartilages.

What Causes Pectus Excavatum?

While the cause is unknown, the fact that it tends to happen in families suggests that genetics may play a role.

Excessive growth and structural abnormalities of the cartilage (tough, connective tissue) of the ribs and breastbone are present in pectus excavatum. Also, pectus excavatum is seen in some inherited connective tissue disorders like Marfan syndrome, homocystinuria, and Ehlers-Danlos syndrome.

What Conditions Are Associated With Pectus Excavatum?

Some children (15%) with pectus excavatum also have scoliosis (curvature of the spine). Some (15%-20%) have mitral valve prolapse, when one of the heart valve’s flaps, which works like a hinge on a door, doesn’t close properly. Connective tissue problems with the major blood vessels and heart valves are also seen.

Although rarely seen, some children have other connective tissue disorders, including arthritis, abnormal growth, and vision and hearing problems.

How is Pectus Excavatum Diagnosed?

Diagnostic imaging tests such as cardiac magnetic resonance imaging (MRI) are done to see the anatomy of the chest. The cardiac MRI is preferred over the CT scan. This is because the MRI shows how the heart is affected without radiation.

An electrocardiogram (ECG or EKG) may be done. An EKG is a test that records the electrical activity of the heart, showing abnormal rhythms and detecting heart muscle stress.

To check for breathing problems related to pectus excavatum, your child may have a breathing test done called a Pulmonary Function Test (PFT).

A Complex Exercise Test (CPET) shows if the condition is making it hard for your child to exercise.

How is Pectus Excavatum Treated?

Younger patients with mild dips can be corrected with a non-surgical vacuum bell treatment. Patients with moderate to severe problems may need surgery. This is not usually done in children younger than age 12 years old. Since children have softer cartilage and more flexible bones than teenagers, the surgery is easier to perform on them and the cosmetic results are better. But now, even young adults are having good outcomes.

Infants and very young children are usually not considered for surgery unless very severe abnormalities or other illnesses require earlier surgery.

What Are The Surgical Procedures for Pectus Excavatum?

Minimally Invasive Surgery (Nuss Procedure)

Minimally invasive surgical techniques have been used for more than three decades. With this approach, two small lateral incisions (cuts) are made. A minimum of two bars that have been shaped to the desired chest contour are inserted one at a time into and across the chest below the sternum (breastbone). This is done using an endoscope (instrument used to see the inside of the chest). The bars are held together by bridge connectors that prevent movement of the bars as the chest is reshaped.

Pain Management Options:

Cryoablation:

Cryoablation is a procedure that involves freezing the outer portion of the nerve sheath. This is done while the patient is still under anesthesia and asleep. This makes the area numb longer. It normally takes three months for the outer portion of the nerve to grow back and for the feeling to return. It takes about 24 hours for the cryo to fully take effect.

ES Catheters:

ES catheters are a form of pain management where small catheters are inserted into the muscles of the patient’s back while they are under anesthesia and asleep. The catheters give continuous numbing medication and stay in place for five days. Patients will go home with these catheters and caregivers will be taught how to take them out on day five. The anesthesiologist will call you each day you are home with the catheters to see how your child is doing.

Regardless of which pain management method is used, most patients have the same pain relief by week two to three. Patients may have some residual numbness that doesn’t go away until the bars are removed.