What is pectus excavatum?
Pectus excavatum is an abnormal development of the rib cage in which the breastbone (sternum) grows inward, which causes a sunken chest wall. Sometimes called "funnel chest," pectus excavatum is often present at birth (congenital) and can be mild or severe. If left untreated, pectus excavatum can sometimes cause compression (pressure) of the heart and lungs.
Pectus excavatum is not preventable, but it is treatable. In addition to causing an unusual appearance of the chest wall, pectus excavatum can also force the heart into the left chest to varying degrees, depending on how severe the condition is. Contact your doctor if the following symptoms occur:
- Trouble breathing
- Decreased exercise tolerance
- Chest pain
What causes pectus excavatum?
The cause of pectus excavatum is not well understood. Researchers believe it is caused by irregular growth of the connective tissue (cartilage) that joins the ribs to the breastbone (also known as the costochondral region), which causes the breastbone to move inward.
While most pectus excavatum cases are not associated with any other conditions, some disorders can be linked with pectus excavatum, including:
- Marfan syndrome: a connective tissue disorder recognized by long limbs and fingers; chest abnormalities; curvature of the spine; certain facial features; specific changes in the heart valves and aorta, and; displacement (movement) of the lenses of the eyes.
- Rickets: a disease occurring primarily in children, rickets results from a lack of vitamin D or calcium and from insufficient exposure to sunlight, disturbing normal bone growth.
- Scoliosis: a curvature of the spine.
What are the symptoms of pectus excavatum?
Symptoms may be more severe for some patients than for others, and may include any of the following:
- Shortness of breath
- Chest pain
- Fast heart rate (tachycardia)
Who is affected by pectus excavatum?
Pectus excavatum accounts for approximately 90 percent of congenital chest wall growth problems. Approximately 40 percent of pectus excavatum patients have one or more family members with the same defect.
Pectus excavatum occurs more often in men than in women, appearing in one per every 300 to 400 Caucasian male births.
How is pectus excavatum diagnosed?
Before pectus excavatum can be properly treated, it must first be properly diagnosed. Your pediatric surgeon will need to complete a physical exam. Specialists, including a pulmonologist and/or cardiologist, may order additional tests as indicated.
Several tests may be performed, including:
- Chest X-ray
- Computed tomography (CT) scan of the chest
- Echocardiogram (an ultrasound study of the heart)
- Exercise (stress) test
- Pulmonary function (breathing) tests
- Laboratory studies (blood work)
- Electrocardiogram (EKG)
How is pectus excavatum treated?
If pectus excavatum is causing problems for either the heart or lungs, your doctor may recommend surgery. Surgery for pectus excavatum has been shown to cause great improvement of symptoms because of changes in heart and blood vessel (cardiovascular) function. Your surgeon will discuss with you the best surgical approach to correct your condition.
The main goals of pectus excavatum repair are to improve the patient’s breathing, posture, and cardiac (heart) function. These objectives can be accomplished with several surgical procedures, including:
- The Nuss Procedure: a minimally invasive technique to correct pectus excavatum.
A small incision (cut) is made to insert a camera to allow the surgeon to see the inside of the chest during the procedure. Through two other small incisions on either side of the chest, a curved steel bar to reverse the depression (individually curved for each patient) is inserted under the breastbone. The steel bar is then fixed to the ribs on either side. A small steel grooved plate may be used at the end of the bar to help stabilize and attach the bar to the rib. The bar is not visible from the outside and stays in place for two to three years. The bar is then surgically removed.
After surgery, patients remain in the hospital for five to seven days for pain management. They are then sent home and usually need pain medication for several weeks. Activity is strictly limited for three months after surgery, and patients are not allowed to take part in any contact sports or heavy activity for six months.
- The Ravitch Procedure: The Ravitch Procedure is completed with an incision in the mid-chest area to remove anterior (front) cartilage. Stainless-steel struts are placed across the anterior chest to support the breastbone and are wired to the appropriate ribs on each side, allowing the breastbone to be elevated (raised). The struts are not visible from the outside and are removed later during a surgical procedure.
Compared with traditional surgery, patients who undergo laparoscopic or minimally invasive surgery to repair pectus excavatum with the Nuss Procedure may have smaller incisions, a possibly reduced risk of infection, and less bleeding.
The Ravitch Procedure offers a shorter hospital stay and less pain after the procedure.
The outlook for patients who have repair of pectus excavatum is generally very good. Patients are usually very satisfied with their appearance, and many notice improved exercise tolerance and stamina.
What are the risks of surgical repair of pectus excavatum?
The surgical repair of pectus excavatum, like other extensive surgical procedures, carries certain risks. While both the Nuss Procedure and the Ravitch Procedure are safe and effective, complications can occur, including:
- Pneumothorax (a buildup of air or gas in the pleural space around the lung)
- Pleural effusion (fluid around the lung)
- Pericarditis (inflammation around the heart)
- Bar displacement (movement)
- Pectus excavatum recurrence (return)
What is the prognosis (outlook) for patients who have pectus excavatum?
The outlook for patients who have pectus excavatum is generally very good. Patients who have surgery are usually very satisfied with the results and with their appearance.
- Fonkalsrud EW, Dunn JCY, Atkinson JB. Repair of pectus excavatum deformities: 30 years experience with 375 patients. Annals of Surgery, March 2000. 231(3):443-8.
- Fonkalsrud, EW. Current management of pectus excavatum. World Journal of Surgery, May 2003. 27(5):502-8.
- Haller JA Jr, Loughlin GM. Cardiorespiratory function is significantly improved following corrective surgery for severe pectus excavatum. Proposed treatment guidelines. Journal of Cardiovascular Surgery, February 2000. 41(1):125-30.
- Malek MH, et al. Cardiovascular function following surgical repair of pectus excavatum: a meta-analysis. Chest, August 2006 130(2):506-16.
- Schalamon J, et al. Minimally invasive correction of pectus excavatum in adult patients. Journal of Thoracic and Cardiovascular Surgery, September 2006. 132(3):524-29.
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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 health care provider. Please consult your health care provider for advice about a specific medical condition. This document was last reviewed on: 4/28/2015…#15791