What is Pectus Excavatum?
Pectus excavatum is a deformity of your child's chest. The sternum and some of the ribs grow abnormally, causing a depression in the middle of the chest. The condition is not always noticeable at birth, but often becomes apparent by the time the child is 2 or 3 years old. In some cases, the condition does not show up until your child is older.
Severity ranges from mild to severe, but the condition tends to worsen during growth spurts. While many children with pectus excavatum do not need treatment because their condition is very mild, more severe cases can put pressure on the heart and lungs. However, the effects on the heart and lungs are usually minor and usually only occur during extreme physical exertion.
In addition, about 15% of children with pectus excavatum eventually develop a condition called scoliosis (curvature of the spine).
What are the symptoms of pectus excavatum?
The symptoms of pectus excavatum depend on when the disease was diagnosed. In early childhood, symptoms of pectus excavatum may include:
- a depression in the chest, which may be wide and shallow, deep and narrow, or irregular in shape.
- breathing faster than usual
In older children, symptoms of pectus excavatum may include:
- shortness of breath on exertion or
exercise
- chest pain
- Lateral curvature of the spine, no curvature of the upper back, hooked shoulders and a broad and thin chest
What causes pectus excavatum?
The cause of the pectus excavatum is unknown. Some research into the genetic component is ongoing. Although in most cases the family history is unrelated, in many cases it is - enough to justify the suspicion that genes may play an important role.
How is pectus excavatum diagnosed?
Funnel-shaped deformity is usually diagnosed during a physical examination. A chest x-ray may also be helpful.
Other tests your child's doctor may recommend include:
- electrocardiogram (ECG or EKG)
- echocardiogram (ultrasound of the heart)
- pulmonary function test (PFT)
What are the treatment options for pectus excavatum?
If your child has a mild form of pectus excavatum, there is probably no reason for surgery. A shallow excavatum is unlikely to affect the functioning of the heart or lungs, and your child's appearance will remain normal.
If the deformity causes physical or social problems, it can be corrected with surgery. There are two surgical options, both of which require your child to be under general anesthesia.
Ravich
In this procedure, the surgeon makes an incision in the child's chest, removes cartilage stuck between the ribs and the breastbone, and repositions the freed breastbone. A barbell is left in the chest wall to maintain the correct shape for six months. During this time, your child will need to refrain from activities that could lead to a collision, such as playing football. The technique eliminates the problem, but leaves a visible scar on the chest.
Nass
In this procedure, the surgeon makes incisions on the side of the baby's chest. The surgeon then inserts the rod from the side through the chest and moves the sternum forward. The cartilage is not removed and the scars are less extensive.
The Nass procedure does not correct your child's chest asymmetry. The bar should be held for at least a year, and sometimes two.
What are the benefits of fixing my child's pectus excavatum?
Although most children with pectus excavatum do not require treatment, more severe cases can be treated with surgery so your child can lead a normal, active life.
In severe cases, pectus excavatum repair can improve heart and lung function. But in most cases, the benefits are mostly psychological. For children who have been upset about their appearance, surgery can make a big difference.