Pectus Excavatum

What is Pectus Excavatum?

In pectus excavatum, a person’s sternum, or breastbone is sunk into their chest. The condition is noticed shortly after birth, is exacerbated by the growth spurt that happens when the child enters adolescence and continues to worsen as the adolescent becomes an adult. It strikes boys more often than girls. Others at risk for the condition have certain genetic conditions such as Marfan syndrome, Ehlers-Danlos syndrome or Noonan syndrome.

Even mild cases of pectus excavatum can make a child feel self-conscious during situations where they need to disrobe, as in gym class or around a swimming pool. In severe cases of pectus excavatum, the sternum may be so sunken in the chest that it interferes with the operation of the patient’s lungs and heart. The heart can actually be squeezed to one side of the chest, and the lungs have less room to expand.

Pectus Excavatum Causes & Symptoms

Doctors don’t know what causes this condition, though many believe it can be inherited, as it runs in families.

When the compressed breastbone affects the heart and the lungs, the symptoms include:

• Heart palpitations or tachycardia
• Heart murmur
• Respiratory infections that keep coming back
• Coughing
• Pain in the chest
• Fatigue
• Wheezing

Dr. Stovroff, a pediatric surgeon at Children’s Surgical Associates can often diagnose a case of pectus excavatum simply by examining the patient. But he may order other tests to see if the lungs or heart are affected by the disorder. They include a chest X-ray, CT scan, electrocardiogram, echocardiogram and tests for the patient’s heart and lung function. A CT scan may be necessary in order to measure the Haller Index, or the Pectus Severity Index. This is a ratio that measures the deformity of the patient’s chest. It needs to be above 3.2 to qualify for surgical correction.

Dr. Stovroff of Children’s Surgical Associates performs pectus excavatum surgery in Atlanta Georgia and has performed over 150 operations of this kind. Surgery is for patients whose heart and lungs are being adversely affected by their disorder. The surgeries are best performed during the adolescent growth spurt, though they can be performed successfully on adults. Patients whose symptoms are mild can be helped with physiotherapy that helps the chest expand and improves their posture.

There are two main types of surgery to treat the condition:

Open Surgery

In open surgery, Dr. Stovroff makes a large, horizontal incision in the center of the chest to expose the patient’s breastbone. The pediatric surgeon will remove the malformed cartilage that attaches the ribs to the lower part of the breastbone and use metal struts or mesh to position the sternum in a way that is more normal. Sometimes he’ll put a break in the sternum to make it easier to position. This operation, called the Ravitch Procedure, takes about four hours. Dr. Stovroff removes the struts or support after six months to a year.

Laparoscopic Surgery

This surgery is less invasive and allows the pediatric surgeon to see inside the patient’s chest through a small fiber optic camera attached to a monitor. This helps him position one or two curved bars beneath the breastbone and raise it. The bar or bars are left in for about two to three years then removed. By then, the breastbone has been trained to stay in a normal position in the chest. This operation takes about one to two hours and is called the Nuss Procedure.

Pectus Excavatum Recovery

Though the great majority of patients who have their pectus excavatum surgically corrected are happy with the procedure, recovery is painful. The patient will need to stay in the hospital in order to control their pain for around two to three days. This is most often done by giving the patient pain medicine through an intravenous catheter which they control. Constipation is often a problem for people who’ve had anesthesia and pain medicine, and the patient will be put on laxatives for a time.

Despite this, the patient will be encouraged to get out of bed and walk around the day after their surgery. They’ll also be expected to practice deep breathing to support the health of their lungs and prevent complications such as pneumonia.

When the patient only needs oral analgesics to control their pain, they can be discharged from the hospital and will be seen in follow-up one week later.

Once home, the patient can take a shower five days after the operation. They can resume sports and other strenuous exercise when the doctor says it’s safe to do so, though really rough sports such as football shouldn’t be practiced for at least three months. The patient should avoid MRIs while they’re wearing the bar.

The patient or their parents should make sure that they keep post-operative appointments with Dr. Stovroff and his staff at the Children’s Surgical Associates. This is the only way to make sure all is going well.  This will be done on a three month interval for about three years.