Pectus excavatum — also known as “sunken chest” or “funnel chest” — occurs when an abnormal growth of cartilage within the chest wall pushes the sternum and ribs inward, creating a caved-in or sunken appearance. It is the most common chest wall deformity, occurring in 1 in 400 births and found in 2.6 percent of seven- to 14-year-old children.
Most kids begin showing symptoms of pectus excavatum during adolescence as their bones grow rapidly. Though it is typically a standalone condition, up to 20 percent of patients might have additional skeletal conditions, such as scoliosis.
Depending on its severity, pectus excavatum might cause your child to experience shortness of breath and heart palpitations, especially during exercise. It could also cause your child to feel self-conscious or anxious about his or her appearance.
Pectus Excavatum Diagnosis and Treatment
Because of its visual nature, pectus excavatum can usually be diagnosed during a physical examination. To determine the severity of the condition, your medical team might also order a series of tests, including an echocardiogram, pulmonary function test or CT scan.
Initial care might include monitoring your child’s growth and chest-specific physical therapy. However, over time, surgical correction is frequently recommended. We perform two different types of surgery, and the decision about which procedure to perform is based on a number of factors that are specific to each patient.
In most cases, we perform a minimally invasive surgery called the Nuss procedure, where we make small incisions on both sides of the chest wall and insert one or more custom-fitted steel bars into our patient’s sternum. The bar(s) would remain in place for two to three years and then be removed during a minor outpatient surgery. Patients are left with small scars after completing this treatment.
If the Nuss procedure isn’t appropriate, we would perform a surgery called the Ravitch procedure. Instead of small incisions, we would make one large incision in your child’s chest, remove abnormal cartilage, place the sternum in an appropriate position and, in rare occasions, insert one or more steel bars to support and elevate the area as it heals. If we insert bars, they would be removed on a later date. The Ravitch procedure is especially well suited for patients who do not wish to have a bar in place for more than one year and those with highly asymmetric chest wall deformities or problematic lower rib flaring.
Both of these procedures are performed while your child is under general anesthesia. Sometimes prior to surgery, an anesthesiologist will insert an epidural catheter into your child’s back while he or she is asleep. An epidural is a small tube that allows your child to receive pain medication after surgery.
When your child is awake in the recovery room, our nursing team and anesthesiologist work together to ensure her or she is as comfortable as possible. Your child might receive a combination of intravenous (IV) and oral pain medications after surgery, which could include the epidural or a patient-controlled analgesia (PCA) pump.
For both the Nuss procedure and the Ravitch procedure, the average hospital stay is four to seven days. Once your child is ready to go home, the IV pain medications are stopped and he or she is transitioned to oral pain medications. Most children will require two to three weeks of oral pain medications after they are discharged.
In less severe cases, we offer a noninvasive, nonsurgical treatment called “the vacuum bell.” This is essentially a large suction cup that creates a vacuum seal on your child’s chest wall and lifts the sternum, correcting pectus excavatum over time. The vacuum bell does not interfere with the patient’s daily activities, such as school and sports.