Cardiovascular and Thoracic Surgery

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Pectus Repair Pectus escavatum

About Pectus Escavatum (PE)

Pectus excavatum (PE) is the most common congenital deformity of the anterior wall of the chest, in which several ribs and the sternum grow abnormally. This produces a caved-in or sunken appearance of the chest. It can either be present at birth or not develop until puberty. Approximately one out of 300-400 males experience this condition.

Pectus excavatum is sometimes considered to be cosmetic; however, depending on the severity, it can impair cardiac and respiratory function and cause pain in the chest and back. People with the condition may experience negative psychosocial effects, and avoid activities that expose the chest

The cause of pectus excavatum is not well understood, but research suggests that the deformity is caused by excessive growth of the connective tissue (cartilage) that joins the ribs to the breastbone (also known as the costochondral region), which causes an inward defect of the sternum.

How is pectus excavatum diagnosed?

Before pectus excavatum can be properly treated, it must first be properly diagnosed. Your doctor and other specialists, including a thoracic surgeon and pulmonologist, will perform a complete physical exam and comprehensive blood tests to confirm the diagnosis.

Several other tests may be performed, including

  • Physical (stress) test
  • Pulmonary function test
  • Laboratory studies (blood work), such as chromosome studies or enzyme assays
  • Metabolic studies
  • Chest x-ray
  • Computed tomography (CT) scan of the chest
  • Electrocardiogram (EKG)
  • Echocardiogram (a picture of the heart)
Treatment

Since most patients with the deformity do not have symptoms, treatment may not be needed, or will be dependent upon the development of symptoms.

Physical therapy in young patients (under the age of 18, due to most pectus deformities remaining the same after this age) may play a role in slowing the development of the chest wall deformity and may possibly reverse some of the chest wall deformity.

If pectus excavatum is affects either the heart or lungs, your doctor may recommend surgery. A recent review of surgeries performed to correct PE showed that surgical repair significantly improves cardiovascular function.

The primary goal of pectus excavatum repair surgery is to correct the chest deformity to improve a patient’s breathing, posture and cardiac function. This is typically accomplished by removing a portion of the deformed cartilage and repositioning the breastbone.

UTMB offers the Nuss Procedure to repair pectus excavatum. Usually restricted to adolescent patients, surgeons use a video-assisted thoracoscopic surgery (VATS) technique to correct PE. Through two small incisions on either side of the chest, a curved steel bar is inserted under the sternum. Individually curved for each patient, the steel bar is used to ‘pop out’ the depression and is then fixed to the ribs on either side. A small steel, grooved plate may be used at the end of the bar to help stabilize and attach the bar to the rib. The bar is not visible from the outside and stays in place for a minimum of two years. When it is time, the bar is removed as an outpatient procedure.

A separate, small incision is made to insert a tube with a camera to allow the surgeon to visualize the inside of the chest and insert tools in the remaining small incisions to complete the procedure.Your surgeon will determine the best surgical approach to correct your condition.

Benefits of Minimally Invasive Surgery

As compared with traditional surgery, patients who undergo laparoscopic or minimally invasive surgery to repair pectus excavatum, such as VATS with the Nuss Procedure, may experience:

  • Decreased postoperative pain
  • Shorter hospital stay
  • More rapid recovery and return to work
  • Other possible benefits include reduced risk of infection and less bleeding.