Pectus excavatum is an abnormal development of the rib cage in which the sternum (breastbone) grows inward, resulting in a noticeable and sometimes severe indentation of the chest wall. Also known as “sunken chest” or “funnel chest,” pectus excavatum can be corrected with the minimally invasive surgical technique called the Nuss procedure or with traditional open surgery, known as the Ravitch procedure. Pectus excavatum occurs in both children and adults but is most commonly noticed in the early teen years. Adults have often been aware of their pectus for many years before seeking treatment.
Due to the pectus, patients may have less space in the chest, which can limit heart and lung function. The symptoms can be both physical and psychological. Physical symptoms can include:
Psychological symptoms can include:
Pectus excavatum is a fairly common congenital (there at birth) deformity. It occurs more often in men than women. Patients should seek treatment if they are having physical symptoms and/or psychological symptoms from their pectus.
The diagnosis of pectus excavatum is made with a simple physical examination. Quite often, the defect does not become noticeable until the early teen years. A more detailed workup, including chest imaging by MRI or CT scan and cardiopulmonary (heart and lungs) exercise testing, accurately measures how serious the pectus is and its effect on cardiopulmonary (heart and lung) function. Echocardiogram and pulmonary function tests (PFT’s) may also be used to evaluate pectus excavatum.
Pectus excavatum can be treated surgically. The primary goal of surgery for pectus excavatum is to correct the chest deformity to improve a patient’s breathing and cardiac function. Repositioning the sternum to a more normal, outward position lessens pressure on the heart and lungs, allowing them to function more normally. The appearance of the chest is also dramatically improved, addressing any psychological symptoms that may also be present.
Pectus excavatum can be corrected with the minimally invasive surgical technique called the Nuss procedure or with traditional surgery, known as the Ravitch procedure. Both procedures are performed at the Cleveland Clinic. Your surgeon will discuss which procedure is the most appropriate based on several variables.
The goal of pectus excavatum repair is to relieve pressure on the heart and lungs that may impair function. This typically leads to improvements in breathing, exercise intolerance and chest pain. It is not uncommon for patients with pectus excavatum to feel as if their breathing and stamina are normal before surgery and then realize they feel much improved following correction.
In patients whose main issue is the abnormal appearance of the chest, there have been dramatic, positive changes in their self-esteem and self-confidence. Complete resolution of clinical depression, including the ability to discontinue medications that had been required for depression, has been seen in patients.
Both the Ravitch and Nuss procedures have excellent results, and patients are almost always satisfied with the way they feel and look following recovery. The recurrence (happens again) rate for both procedures is less than 1%.
The surgical repair of pectus excavatum, like other major surgeries, presents risks. While both the Nuss procedure and the modified Ravitch technique are safe and effective procedures, complications, although rare, can occur.
Possible complications from surgical repair of pectus excavatum include:
There is no evidence that pectus excavatum limits life expectancy or causes progressive damage to the heart and lungs over time. It is not uncommon for individuals to develop more symptoms over time. This is likely due to the normal aging process and increasing difficulties compensating for the functional impairments associated with pectus excavatum. This, however, does not mean damage is occurring.
Yes. Doctors have done combined heart surgery cases with pectus excavatum repair with excellent outcomes. This requires a coordinate approach between the surgeons performing both procedures.
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This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or healthcare provider. Please consult your healthcare provider for advice about a specific medical condition. This document was last reviewed on: 01/05/2018