Pectus Excavatum

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CHKD Nuss Procedure Patient

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Procedure for Pectus Excavatum

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Click on the image to learn more about this minimally-invasive procedure for pectus excavatum.

Click the image to learn more about how the deformity inhibits chest wall motion.

What is pectus excavatum?

Pectus excavatum is a condition that affects the breastbone (sternum) and the ribs. It appears as a depression – or indentation – in the middle of the chest and is sometimes described as “sunken” or “funnel” chest. Pectus excavatum is not rare. One in every 1,000 children has some form of the condition, ranging from mild to severe. It is more common in boys than in girls.

What causes pectus excavatum?

The condition is caused by growth of excess connective tissue between the ribs and the breastbone. Research at CHKD has shown that pectus excavatum frequently runs in families, meaning that many cases are likely caused by genetic factors. Individuals with connective tissue disorders such as Marfan syndrome have increased rates of pectus excavatum.

Are children born with pectus excavatum?

The condition can be present at birth, but it doesn’t affect growth or development. As the children grow, the chest depression often becomes more pronounced and may cause symptoms.

What symptoms does it cause?

Patients often experience psychological distress and negative body image. Mild cases may cause no physical symptoms, but deeper indentations of the chest wall may press on the heart and lungs, making it difficult for children to exert themselves. Shortness of breath while exercising is the most common symptom.

Normally, the chest wall expands when a child inhales, allowing more air to move in to the lungs. In some patients with pectus excavatum, however, the middle of the chest seems to deepen rather than expand during inhalation. Doctors call this paradoxical chest wall motion.

While physicians have noticed this unexpected movement for many years, they have not had a way to measure it. Today, a motion analysis lab in CHKD’s pectus program offers state-of-the art Opto-Electronic Plethysmography (OEP) equipment to evaluate the breathing of pectus patients.

OEP testing is based on the same technology used to create lifelike human figures for video games. Sensors placed on the patient’s chest record and process movement, creating a three-dimensional model of the chest wall during breathing. Click here to see an example.

OEP testing gives surgeons valuable, detailed information about volume variations of the whole chest and abdominal wall as well as separate areas of each. It also helps surgeons detect asymmetries in the action of the many muscles required for breathing. Testing before and after surgery is helping surgeons gain a better understanding of how pectus excavatum and the Nuss procedure affect breathing.   

How is it treated?

In the past, pectus excavatum was often considered “merely” a cosmetic issue.

Nearly 20 years of research and experience caring for patients with the condition has changed that perception. Because the deformity can cause both physical and emotional problems for children, we recommend that all cases be evaluated by a physician according to guidelines we have developed based on our work with thousands of young people with pectus excavatum.

There are several different options for treatment, including the Nuss Procedure. The surgeons at CHKD are world-renowned for their expertise in chest wall deformities and can help you select the best treatment option for your child based on his or her age and specific needs.