Pectus Excavatum and Pectus Carinatum
Florida's Leader in the Treatment of Chest Wall Deformities
The Chest Wall Deformity Center of Excellence at Nicklaus Children's Hospital, formerly Miami Children's Hospital, is Florida’s leader in the assessment and treatment of chest wall deformities, and is the only center in the state offering comprehensive treatment for the more rare pectus carinatum.
In addition to congenital chest wall deformities, the center also provides care for children and teens with chest irregularities occurring as a result of cancer surgery. Chest wall deformities, including pectus excavatum (sunken chest) and its opposite, pectus carinatum (protruding chest), affect one in 400 children or teens.
Nicklaus Children's Hospital has long been a leader in treatment of chest wall deformities. Over the decades, hundreds of patients have enjoyed the physiologic and esthetic benefits of chest remodeling. In 1997, the surgeons here were the second in the nation to perform the minimally invasive Nuss repair for pectus excavatum.
Conditions we Treat
Pectus excavatum, Latin for “hollowed chest,” is the most common chest wall deformity. It may also be referred to as sunken chest, hollow chest, or concave chest. This condition is characterized by a distinctly depressed sternum (breastbone), which in some patients is evident at birth, and for others develops later, typically during adolescence. In severe cases, pectus excavatum can affect the heart and lungs, while less severe cases often impact a child’s or teen’s self-image.
Patients with pectus excavatum may experience shortness of breath, chest pain, and exercise intolerance. Pectus Excavatum treatment may include surgery to relieve discomfort and prevent heart and breathing abnormalities.
Pectus Excavatum: before and after treatment
Patient Evaluation by the Center:
Physicians at the Chest Wall Deformity Center use computed tomography (CT) scans to image the internal stucture of the chest to access of the severity of the depression. They may also arrange for pulmonary function and cardiac evaluations to determine the impact of the deformity on each individual.
The Haller index(dividing the width of the rib cage by the distance from the sternum to the spine) is often used to evaluate the severity of pectus excavatum. A normal index is about 2.5, while an index greater than 3.2 may be severe enough to indicate surgical correction.
Pectus Excavatum Surgery Options:
The Chest Wall Deformity Center offers both traditional surgeries as well as minimally-invasive operations for pectus excavatum treatment. Options are reviewed and a course of treatment for pectus excavatum is selected with imput from the family, based onthe severity and asymmetry of the defect. Operative repairs is customized to best correct the specific condition noted in each patient.
The Ravitch procedure, developed in the 1940s, is a technique that involves opening the chest cavity. With this technique, small sections of rib cartilage are removed, and the sternum is raised. Metal bars, called struts, may be implanted to hold the chest wall in place to reshape the chest. These may then be removed about six months after the operation.
The Nuss procedure, developed in the 1990s, is a minimally invasive procedure. With this pectus excavatum treatment, a small incision is created under each armpit, with a third tiny incision made for insertion of a thin camera. The camera guides the surgeon in implanting a curved metal bar under the sternum allowing immediate correction of the sunken appearance of the chest. These bars may be removed after several years, once the new bone structure is established.
Pectus carinatum, also known as pigeon chest, is a chest wall deformity in which the sternum (breastbone) and ribs protrude. Other names are chest protrusion, protruding chest or protruding sternum. The condition may be caused by excessive growth of cartilage. Pectus carinatum can be present at birth, although it can also occur during adolescence, emerging suddenly during the growth spurt at puberty. The condition can be associated with certain genetic disorders or syndromes, and sometimes arises following open heart surgeries in which the sternum is split.
Pectus Carinatum: before and after treatment
Patient Evaluation by the Center:
Pretreatment assessment of pectus carinatum may include physician evaluation, photos and measurements of the chest wall.
The Chest Wall Deformity Center of Excellence at Nicklaus Children's Hospital is the only facility in Florida to offer an FDA-approved bracing treatment for pectus carinatum in addition to comprehensive surgical options for children and teens.
Chest bracing therapy is a nonsurgical method to treat pectus carinatum that utilizes a customized chest-wall brace, custom built for the specifics of each patient, to reduce the chest protrusion over time. The brace is worn under clothing and, in combination with an exercise program, may completely correct the problem. The duration of bracing depends on the type and severity of the protrusion, but most defects typically respond well with six to eight months of treatment.
Surgical Treatment Options:
Pectus Carinatum treatment may involve surgery for some patients with moderate conditions, as well as those who cannot tolerate bracing.
The Ravitch technique, developed in the 1940s, is similar to the procedure developed for pectus excavatum and involves opening the chest wall. With this technique, small sections of rib cartilage are removed. The sternum is then flattened, with correction noted immediately after surgery.
Innovative surgery for patients with sunken chest
Approximately one in 1,000 children suffers from pectus excavatum, a congenital deformity of the chest in which the sternum or breastbone faces inward, applying pressure to the heart and lungs. This disorder can restrict the growth of the vital chest organs, becoming more serious as a child grows up. Symptoms of this disorder may include chest pain, mitral valve prolapse, heart palpitations, respiratory disease and exercise intolerance.
Our pediatric surgical team has applied an innovative surgical treatment to correct this condition, with numerous benefits to young patients. Using minimally invasive surgical procedures, a stainless steel bar is implanted to reshape the patient's sunken chest. This bar supports the chest until the child's body has molded to a more normal position, a process that takes approximately two years in most cases.
Pectus excavatum surgery requires only a few incisions, reducing scarring, and requires approximately 40 minutes, compared to the four to six hours required for chest reconstruction. Blood loss is also minimal compared with other procedures. Children usually can return to their normal activities in about a month.
Pectus excavatum surgery provides excellent long-term functional and cosmetic results, making it easier for the child to breathe, while restoring normal chest expansion and proper lung and heart growth.