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WHAT IS PECTUS EXCAVATUM?

Pectus Excavatum (also known as funnel chest) is a medical condition where the breastbone is sunken into the chest. The range in which Pectus Excavatum sinks into the chest depends on the severity of the condition. 

 

FUN FACTS:

  • Pectus Excavatum is a birth defect that becomes most notable during puberty.

  • Pectus Excavatum is five times more common in boys than girls.

  • Occasionally, Pectus Excavatum runs in families.

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Symptoms may include:  

  • The sunken appearance of the sternum

  • Displaced heart

  • Decreased lung capacity (trouble breathing)

  • Chest pain

  • Fatigue 

  • Wheezing/Coughing

  • Respiratory infections

  • Heart murmur

  • Rapid Heartbeats 

  • Dizziness

Diagnosis:

Pectus Excavatum is commonly identified by visual examination of the chest. Despite this, medical professionals still use other tests to ensure the validity of the diagnosis. Electrocardiograms are used to determine the normality of heartbeat by applying electrical leads with adhesive. Another test utilized is the Echocardiogram which is an ultrasound of the heart that discovers the productivity of the valves and heart function. Additionally, Spirometry is a lung function test that measures breathing patterns by having the patient breathe into a mouthpiece. A CT scan is a computed tomography scan used to distinguish the mediastinal shift and degree of deformity. This degree of deformity is measured using the Haller index (HI) which is the distance of the inside ribcage divided by the distance between the sternal notch and vertebrae. A normal Haller Index is 2.0, a mild Pectus Excavatum Haller Index is between 2.0-3.2, a moderate Pectus Excavatum Haller Index is between 3.2-3.5, and severe a Pectus Excavatum Haller Index is >3.5. Medical professionals also use chest x-rays to diagnose Pectus Excavatum. Chest x-rays can display the heart displacement and severity of the chest's indent.

Complications:

Unfortunately, Pectus Excavatum has numerous correlations to other medical conditions like... 

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  • ​Scoliosis ​(abnormal twisting and curvature of the spine) 

  • Rickets (softening and weakening of bones in children)

  • Marfan Syndrome (a genetic condition that affects the body's connective tissue)

  • Noonan Syndrome (a genetic disorder that prevents growth in different parts of the body)

  • Ehlers-Danlos syndrome (a group of inherited disorders that affect your connective tissues)

  • Poland syndrome (a disorder that causes muscles to not develop fully or at all)

  • Flared Ribs and Shoulder Blades (the lower portion at the front of your rib cage protrudes forwards and out/ scapular winging involves one or both shoulder blades sticking out from the back)

  • Bad Posture (a body position that is asymmetrical or non-neutral)​

 

Not to mention, Pectus Excavatum can relocate the heart and lungs and cause several mental health issues like anxiety, depression, and decreased self-esteem. 

TREATMENT

Treatment for Pectus Excavatum can be either invasive or non-invasive depending on the situation. The most common treatments are the Nuss procedure, the Ravitch technique, and the Vacuum Bell. The best time for invasive treatments is during adolescence because the bones are still malleable, making surgery and post-recovery easier and safer. Despite this, adults can still receive invasive treatments.

 

Nuss ProcedurE:

The Nuss Procedure is a 1-3 hour long invasive surgery that corrects Pectus Excavatum by placing a curved metal bar under the breastbone. The amount of metal bars placed depends on the severity; some patients only need one bar, while other patients need two or more bars. During surgery, the surgeon creates two 1-inch incisions, one on each side of the chest, so that they can implement the bar(s).  Then the surgeon uses a little camera to guide the metal bar under the breastbone, rotating the bar to lift the chest. Finally, the surgeon removes the camera and closes the incisions. After 2-3 years the bar will be removed. ​

 

NUSS PROCEDURE RISKS:

  • ​Bleeding​

  • Infection

  • Misplaced bars

  • Pain

 

RAVITCH TECHNIQUE:

The Ravitch Technique is a 4-6 hour long invasive surgery that corrects Pectus Excavatum by creating a long incision across the chest and placing a small metal bar under the breastbone. During the surgery, the surgeon creates the incision and removes deformed cartilage. A cut is then made in the breastbone so it can be raised properly; occasionally, surgeons use a strut or metal bar to keep the breastbone in the correct position as it heals. Finally, the surgeon closes the incisions and the cartilage regenerates keeping the breastbone in the correct position. After 6-12 months the metal supports are removed (if used). 

 

RAVITCH TECHNIQUE RISKS:

  • Fluid collection under the skin

  • Collapsed Lungs

  • Misplaced Bars

  • Damage to the heart and lungs

  • Pectus Excavatum Reappears

  • Pain

VACUUM BELL:
The Vacuum Bell is a 1-year long non-invasive treatment that corrects Pectus Excavatum by using suction to pull the chest outward. The Vacuum Bell is a rubber cup-shaped device with a hand pump. The user places the Vacuum Bell onto their chest, pumping the hand pump and creating a suction on the chest. After consistent use, the breastbone should be pulled into the correct position. 

 

VACUUM BELL RISKS:

  • Bruising

  • Sore Chest and Back Muscles 

  • Skin Irritation 

  • Flabby Skin

REFERENCES

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