What is pectus excavatum
Pectus excavatum, a Latin term for “hollowed chest,” is a chest wall deformity in which the sternum caves in, causing a sunken appearance in the chest wall. Also known as “funnel chest”, pectus excavatum is usually congenital and cases may range from mild to severe. It is not preventable, but has very high rates of successful treatment.
Pectus excavatum is often diagnosed and treated at birth or during childhood. Occasionally, it goes untreated and needs to be repaired during adulthood. If left untreated, severe cases of pectus excavatum can lead to compression of the heart and lungs.
Cause and risk factors of pectus excavatum
It is not known for certain what causes pectus excavatum. Some of the suspected causes or risks are:
- Excessive growth of connective tissue from the ribs to the sternum
- Genetic link: forty percent of patients with this condition have one or more family members with the same malformation
- Occurs more often in males
Most cases of pectus excavatum are not linked to other conditions. However, some disorders may include a sunken chest wall, such as:
- Marfan Syndrome, a connective tissue disorder
- Rickets, a bone disease caused by vitamin deficiency
- Scoliosis, curvature of the spine
In selected patients with suspicion of a genetic disorder further medical investigations may be indicated to rule out other significant conditions.
Symptoms of pectus excavatum
Although patients with pectus excavatum can be asymptomatic, others present with symptoms including:
- shortness of breath, especially during exercise
- anterior chest wall pain and discomfort
- tiredness and fatigue
Pectus Excavatum can also be associated with certain medical conditions such as:
- cardiopulmonary compromise
- other musculoskeletal abnormalities and connective tissue disorders such as Marfan syndrome
Diagnostic approach to pectus excavatum
A complete medical history and a careful clinical examination by an experienced doctor are necessary to assess the pectus excavatum chest wall deformity. In addition, further investigation can be performed to rule out other clinical conditions and to decide the optimal treatment plan:
- Echocardiogram and ECG
- Lung function test
- CT scan of the chest with 3D reconstruction
Pectus Excavatum – Vacuum Bell
The Vacuum Bell is a non-surgical treatment option for the management of pectus excavatum. The Vacuum Bell uses a suction cup that creates a vacuum seal on the chest wall and lifts the sternum improving the deformity. The device allows patients to use it without interfering with school, sports and other daily activities.
Various studies have shown that Vacuum is a safe therapy for treating pectus excavatum in a non-surgical conservative manner. VBT has been shown to have higher success rates in those who present earlier, have mild, symmetric pectus excavatum, a more compliant chest wall and lack of costal flaring.
Pectus Excavatum – Surgery
There are two types of surgical correction, both done under general anaesthesia, open repair (Ravitch Procedure) and minimally invasive repair with a metal bar (Nuss Procedure), both associated with very good results. The majority of the patients with pectus excavatum are candidates for the Nuss procedure. However, the decision for the patient to undergo a Ravitch or Nuss procedure will depend on the degree of the pectus deformity, the age and lifestyle of the patient and the risks of each procedure.
The Ravitch procedure is performed through a midline incision. During this repair, the abnormal costal cartilages are removed, preserving the lining of cartilage, and the sternum is moved forward in a normal position. In some patients, an osteotomy (a break) in the sternum is done to allow the sternum to be positioned forward and that can be supported with the use of a biosynthetic mesh behind the sternum.
The Nuss Procedure involves the insertion of a stainless-steel bar under the sternum, to push the sternum forward into the correct position. Two incisions are performed on the lateral side of the chest for the insertion of the bar. The bar will stay in for 2-3 years and then it will be removed.