What Is Pectus Excavatum?

Pectus excavatum is a condition in which the cartilage connecting the sternum and ribcage does not grow normally, causing a sunken appearance or indentation in the chest. It occurs most commonly in the early teenage years and affects boys five times more often than girls.

The severity of this condition varies, but your child may experience shortness of breath or fatigue during exercise if his or her ribs and sternum press on the heart or lungs. The appearance is sometimes psychologically challenging. Your doctor can measure the size of the indentation and how it affects your child’s breathing and heart performance. You will likely need to have these tests performed as well: an echocardiogram, an EKG, a CT scan, and a stress test. Your doctor can then advise you on whether your child may benefit from surgery.

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Pectus Excavatum Surgery

Pectus excavatum can be corrected with one of two different procedures, the Nuss procedure or the Ravitch procedure. You might consider these procedures if your child has symptoms like:

  • Chest pain
  • Shortness of breath
  • Chest CT showing a severe indentation or compression of the heart
  • Changes in breathing or heart tests
  • Embarrassment or stress about appearance

In some cases of pectus excavatum, corrective surgery may not be necessary. If the condition does not bother your child, make physical activity difficult, or have a negative impact on your child’s self-image, you can choose not to pursue treatment. This decision will vary from person to person. Talk to your child’s doctor about the best option to fit your child’s needs.

Procedure

The Ravitch procedure cuts away abnormal rib cartilage and repositions the sternum, leaving a bar in the chest.

The Nuss procedure is less invasive and far more common. In this procedure, your child will be measured for a metal bar that will be placed in his or her chest. The surgeon will make two small incisions near each armpit, and then position the bar to raise the sternum and correct the depression in the chest wall. The bar typically will be removed after two to three years.

Your child will be given an IV with medications for pain, anxiety, and muscle relaxation. We encourage you to give your child over-the-counter laxatives for two days prior to surgery to prevent constipation.