Center for Pectus Excavatum
Details about Pectus Excavatum and Carinatum surgery, procedures and treatment at Cleveland Clinic.
Pectus excavatum is a congenital chest wall deformity, sometimes known as"funnel chest" or “sunken chest.” The pectus excavatum defect is characterized by a deep depression of the sternum, typically involving the lower half or two thirds of the sternum. The lower 4-6 rib cartilages dip backward abnormally to increase the deformity or depression and push the sternum backward toward the spine. Other problems, especially in the muscle, skeletal and respiratory system, also may accompany this pectus excavatum defect. Cleveland Clinic Children’s Hospital is currently one of only five centers in the country recognized for excellence in treating pectus excavatum. When you want qualified, certified treatment for pectus excavatum, look to us to deliver.
Among the procedures available to correct pectus excavatum is the Nuss Procedure and the Ravitch Procedure. The Nuss procedure starts with general anesthesia and the placement of an epidural catheter for the management of pain after the operation. Two incisions are made on either side of the chest for insertion of a curved steel bar under the sternum. A separate, small incision is made to allow for a thorascope (small camera) for direct visualization as the bar is passed under the sternum. The bar is individually curved for each patient. The bar is used to pop out the depression and is then fixed to the ribs on either side. The incisions are the closed and dressed. The second procedure available to correct pectus excavatum is called the Ravitch procedure. The Ravitch procedure involves placing stainless-steel struts across the anterior chest to support the breastbone and then wired to appropriate ribs, elevating the breastbone. In treating pectus excavatum, the Ravitch procedure is generally used in the event the child is not eligible for the Nuss procedure.
Pectus excavatum surgery options like the Nuss procedure or Ravitch procedure may involve placing a small steel, grooved plate at the end of the bar to help stabilize and fix the bar to the rib. The bar is not visible from the outside and stays in place for a minimum of two years. When it is time, the bar is removed as an outpatient procedure.
The Nuss Procedure, also known as the “Minimally Invasive Repair of Pectus Excavatum,” uses principles of minimal-access surgery and thoracoscopy combined with the proper placement of a Lorenz Pectus Bar to achieve correction of pectus excavatum.
Cleveland Clinic pediatric surgeons also treat pectus carinatum. Learn more about pectus excavatum and carinatum by downloading a free treatment guide.