Pectus Excavatum

Jagdish Kathwate
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Pectus Excavatum - Patient Education
What is pectus excavatum?
Pectus excavatum (PE) is an abnormal development of the rib cage where the breastbone (sternum) caves in, resulting in a sunken chest wall deformity. Sometimes referred to as "funnel chest," pectus excavatum is a deformity often presentat birth (congenital) that can be mild or severe.

What causes pectus excavatum?
The cause of pectus excavatum is not well understood. Yet, researchers believe 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.
While the vast majority of pectus excavatum cases are not associated with any other condition, some disorders may include the sunken chest feature of pectus excavatum, including:
Marfan syndrome: A connective tissue disorder, which causes skeletal defects typically recognized by long limbs and ‘spider-like’ fingers, chest abnormalities, curvature of the spine and certain facial features including a highly arched palate, and crowded teeth.
Rickets: A deficiency disease occurring primarily in children, Rickets results from a lack of vitamin D or calcium and from insufficient exposure to sunlight, which disturbs normal bone growth.
Scoliosis: A curvature of the spine.

What are the symptoms of pectus excavatum?
Most patients do not have symptoms, though a minority of patients may have the following symptoms:
• Fatigue
• Shortness of breath
• Chest pain
• Fast heart rate (tachycardia)

Who is affected by pectus excavatum?
Pectus excavatum is a fairly common congenital deformity that accounts for approximately 90 percent of congenital wall deformities. Approximately 40 percent of pectus excavatum patients have one or more family members with the same defect.

Is pectus excavatum serious?
Pectus excavatum is not preventable, but the condition is treatable. In rare cases if the condition is left untreated, pectus excavatum can cause compression of the heart and lungs. In addition to pectus excavatum causing an unattractive appearance of the chest wall, the condition can also force the heart into the left chest to varying degrees, depending on the severity of the defect.

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)

How is pectus excavatum treated?
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 compromising either the heart or lungs, your doctor may recommend surgery.
Surgery: 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.

What are the risks of surgical repair of pectus excavatum?
The surgical repair of pectus excavatum, like other extensive surgical procedures, presents risks.
Possible complications from surgical repair of pectus excavatum include:
• Pneumothorax (an accumulation of air or gas in the pleural space)
• Bleeding
• Pleural effusion (fluid around the lung)
• Infection
• Bar displacement
• Pectus excavatum recurrence (due to having the surgical correction completed too early prior to puberty and/or not leaving the strut or bar in place for a long enough period). Recurrence is less likely after the Ravitch procedure.


References
Pectus Excavatum Pectus Excavatum 12/30/2010
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