Chest wall deformities are not just a physical ailment. They can also impact a child’s quality of life. At WVU Medicine Children’s we offer care for the two most common types of chest wall deformities; Pectus Excavatum and Pectus Carinatum.
Pectus Excavatum
Pectus excavatum, also known as know as ‘sunken’ or ‘funnel’ chest, is a condition characterized by depression of the sternum. It produces a caved-in chest or breastbone.
Pectus excavatum is a chest wall deformity that’s present from birth which affects an estimated one in 400 babies. It is three to five times more common in males than females. The depth and shape of the depression determine the degree of heart or lung compression.
Pectus excavatum tends to become more pronounced during the growth spurt before and during puberty. This is also the time when symptoms like shortness of breath, palpitations (fast heartbeat), or pain can arise. Some patients complain of decreased exercise tolerance. It is well known that most affected patients suffer from poor body image, which can have a major impact on their self- esteem as well as their social and emotional development.
Historically, surgical chest wall correction required a large incision with removal and the fracture of several ribs and the breastbone. In 1986, Donald Nuss, MD developed a minimally invasive repair technique of the sunken chest involving a metal implant. This introduces a steel or titanium bar into the chest, pushing the sternum out and correcting the depression. This “Nuss” or “Pectus bar” is individually bent during the operation or prefabricated and inserted via small incisions on the sides of the chest. The bar is advanced under the skin and breast tissue and carefully advanced across the chest under visualization with a small camera. The corrective effect is immediate. Deeper or wider depressions and older teenager frequently require two bars.
The Nuss procedure is a minimally invasive surgical option for patients who suffer from symptoms like shortness of breath and exercise intolerance or pain, but also for patients whose psychological development is at risk. Therefore, consideration for surgical repair includes both, physiologic and psychological aspects.
The depth of the sternal depression and severity of pectus excavatum is assessed on CT scan.
At WVU Medicine Children’s, the use of cryotherapy will help with a patient’s pain. At the beginning of the Nuss procedure, the nerves conducting the pain are numbed by applying a cold probe. This significantly reduces the need for pain medication after the minimally invasive Nuss procedure.
Not every patient with pectus excavatum requires surgical therapy. Alternatives of the Nuss procedure include observation, physical therapy and the vacuum bell.
Pectus Carinatum
Pectus carinatum, also called pigeon chest, is a deformity of the breastbone and ribs that causes the chest to stick out. As with pectus carinatum, this condition can be present at birth. Chest wall deformities run in families, but the cause for pectus carinatum and excavatum is not known.
Some children with pectus carinatum suffer from chest pain, have shortness of breath or exercise intolerance. In many cases chest wall deformities become more pronounced shortly before and during puberty.
As with pectus excavatum, children with pectus carinatum suffer psychologically from their appearance. Some patients experience embarrassment and lack of self-esteem leading to social isolation and withdrawal from school and athletic involvement.
There is a successful noninvasive treatment for those who need or want correction of their chest protrusion – the bracing therapy. Surgical correction involves a procedure under general anesthesia and an incision in the mid-chest to remove abnormal ribs and reshape the sternum. Bracing is a good alternative to surgery for many patients. It requires a long-term commitment.
Teenagers must agree to wear a brace every day for up to one year. Prior to starting the therapy the chest of a patient is being scanned with a 3D scanner. Based on these exact measurements, a customized, individual brace is fabricated for each patient. The brace consists of a metal belt and memory foam-cushioned compression zones on the front and back. It should be worn as much as possible to apply constant pressure on the protruding chest. The brace can be removed for bathing, showering and sports.
At WVU Children’s we will tailor a treatment to your child’s need. Our chest wall team with a dedicated nurse practitioner and staff surgeon will discuss all treatment options and guide you through the treatment process.
Follow ups can be in person, but also at one of your satellite clinics with an Advanced Practice Provider (APP) or at the ease from your home via the MyChart app.
