Treatment for Pectus Excavatum or Sunken Chest

Most children with pectus excavatum—also known as "sunken chest" or "funnel chest"—have few health problems as a result of this condition; however, in some children, it may affect proper heart and lung function.

Child in hospital bed

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The culprit is too much cartilage, a sturdy, pliable tissue that makes up a baby's skeleton. In this condition, extra cartilage forms over the ribs before birth. This condition can become troublesome after infancy as development occurs.

How It Affects Heart and Lung Function 

Here are ways that pectus excavatum can compromise heart and lung function:

  • The cartilage turns to bone. Between birth and 3 years of age, the cartilage of all babies becomes bone, except in certain places where it remains elastic, like parts of the ears and nose. It also lines the joints.
  • The sternum pushes inward. As the cartilage of a child with pectus excavatum hardens, the sternum is pushed inward by the extra amount of cartilage covering the ribs, which creates the "sunken" look. As the process continues through adolescence, the heart may be gradually displaced into the left chest. Pressure from the hardening cartilage can interfere with the ability of the heart to fill with blood and pump it to the body fast enough.
  • Heart and lung size are affected. The heart and lungs may be smaller than normal because there isn't enough room for them to reach normal size. Normal breathing and blood circulation are affected.

In most cases, pectus excavatum results in a heart and lung capacity just slightly below average and doesn't affect day-to-day living. But the heart may not be able to pump well enough to permit strenuous activity.

Even a serious case of pectus excavatum will not threaten life, but it can result in physical disability and is a source of self-consciousness.

These signs suggest pectus excavatum and the associated possibility of heart problems:

Mild breathing difficulties and frequent, long-lasting colds may result from less severe forms of pectus excavatum. Symptoms may worsen with age, leveling off as full size is reached.

Pectus excavatum can be evaluated using x-ray, CT, MRI, lung function tests or echocardiography, which uses sound waves to produce pictures of the heart.

Surgery Can Help

The ideal age for pectus excavatum surgery is older than 6 years, but before adolescence, when bones and cartilage become less pliable. Surgery has been performed on teens and young adults.

Three surgical approaches for surgery exist:

Ravitch Repair: The lower four or five cartilages are removed and the sternum is temporarily supported using a metal bar, which is taken out in about a year. The child is hospitalized for up to 5 days; light activity can begin in a few weeks, but it will be several months before really active play is OK to resume.

Nuss Procedure: A bar in the shape of the desired chest wall is placed below the sternum. The bar is removed about 2 years later. Recovery is similar to that of the Ravitch surgical repair.

Magnetic Mini-Mover Procedure: One magnet is implanted inside the chest and one is placed on the outside nudge rib cartilage of the chest to bring it into a more normal position, which results in correction after several months. Patients go home the same day and can resume activities immediately.

All methods improve the heart's pumping ability, but only in rare cases does surgery improve lung capacity.

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Article Sources
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