Pectus Excavatum
Pectus excavatum, commonly referred to as “sunken chest,” is when the breastbone, or sternum, and some of the ribs grow abnormally and cause a depression in the middle of the chest. It is the most common congenital chest wall abnormality in children. In this video, CHOC pediatric surgeon Dr. Mustafa Kabeer eases your concerns about pectus excavatum, as well as when to know if it needs to be repaired. CHOC treats pectus excavatum with a minimally invasive approach called the Nuss procedure.
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I’m Dr. Mustafa Kabeer and I’m one of the pediatric general and thoracic surgeons here at CHOC Children’s Hospital, and today I’m going to talk to you about pectus excavatum, which is basically sunken chest.
Pectus excavatum is a condition that occurs either initially noted at birth and most frequently just around puberty. The sternum or the mid portion of the chest starts to grow along with the child but starts to grow inwards so it can appear as a sunken chest.
The causes of pectus excavatum are a little bit harder to define. We know that it occurs actually quite often. Every week I see maybe two or three patients in my clinic for this problem. Worries that families may have is that because it looks like it’s intrusive and that their chest may be more at risk of injury, etcetera. But in general we don’t believe that the condition of pectus excavatum is actually dangerous. However, it can cause problems with certain activities that people may choose to do. They may experience shortness of breath. Sometimes they may even get some chest pain where it goes inward. Some people may have some lightheadedness, maybe they can’t exert themselves to their fullest potential.
Pectus excavatum is treated by initially performing some imaging studies such as either a CT scan of the chest or MRI, both to look at the chest and potentially even get cardiac function, as well as pulmonary function testing to see how the lungs are working. And here, because we have a pectus excavatum team, we even have other procedures such as CPX which actually looks at the effects of the heart and the lungs during an exercise stage. Once we get those studies then we go further as to whether operative intervention is indicated.
The surgical approaches for repair of pectus excavatum at this hospital mainly centers around the Nuss procedure. Historically, there was a large intrusive incision and fairly traumatic [method] called a Ravitch procedure. We routinely perform the Nuss procedure which is a minimally invasive approach essentially to provide an internal brace that sits inside the chest for two years, and then it gets removed.
Pediatric surgeons and have a training period that involves extensive training in the repair of pectus excavatum and these congenital chest wall abnormalities. Not only have they had exposure to it but they’ve also learned the latest approaches, such as this minimally invasive Nuss procedure. So it’s very important that when you identify pectus excavatum you seek out all of the options and the proper credentialing and training for these procedures.
