Definition
Pectus excavatum is a condition in which an individual has a breastbone that is sunken into his or her chest due to abnormal formation of the rib cage. Sometimes called funnel chest, the sunken breastbone is often noticeable shortly after birth and worsens during adolescent growth. Pectus excavatum is more common in boys than in girls and can interfere with function of the heart and lungs. Surgery is recommended as a treatment option for correcting the deformity.
Symptoms
For many individuals with pectus excavatum, their only sign or symptom is an indentation in their chests. In severe cases of the condition, the breastbone may put pressure on the lungs and heart. Signs and symptoms may include the following:
- Decreased exercise tolerance
- Chest Pain
- Tiredness
- Coughing
- Trouble breathing
- Fast heart rate
Causes
While the exact cause of pectus excavatum is unknown, it may be a genetic condition because it tends to run in families.
Risk factors
The only current risk factor for pectus excavatum is that it is more common in boys than in girls.
Complications
Severe cases of pectus excavatum can put pressure on the lungs and push the heart over to one side. Even mild cases of pectus excavatum can result in self-image problems.
- Heart and lung problems: In severe cases where the depth of the breastbone indentation is deep, the amount of room the lungs have to expand may be reduced. The pressure can also squeeze the heart, pushing it into the left side of the chest and reducing its ability to pump blood efficiently.
- Self-image problems: Children who have pectus excavatum also tend to have a hunched-forward posture, with flared ribs and shoulder blades. Many are self-conscious and avoid certain activities where their chest indentations can be seen, such as during swimming.
Treatment
Pectus excavatum can be surgically repaired, however surgery is usually recommended for individuals who have moderate to severe signs and symptoms. Individuals with mild signs and symptoms may be helped through physical therapy, by doing certain exercises to improve posture and chest expansion. If surgery is proven necessary, the two most common types of surgeries used to correct pectus excavatum differ by the size of the incisions used:
· Larger incision (The Ravitch Procedure) : A center-of-the-chest incision is made where the deformed cartilage attaching the ribs to the lower breastbone is removed and the breastbone is fixed into a more appropriate position by use of surgical tools.
- Smaller incisions (The Nuss Procedure): Small incisions are placed on each side of the chest, under each arm. Surgical tools and a narrow fiber-optic camera are inserted through these incisions. A curved metal bar is inserted under the depressed breastbone, to raise it into a more appropriate position. In some cases, more than one bar is used. The bars are removed after two years.
When correcting pectus excavatum, results are best achieved when surgery is performed around the growth spurt period. Overall, the outlook for individuals who have undergone surgical repairs of pectus excavatum are usually very good and many are satisfied with their appearance.
