What is pectus carinatum?
Pectus carinatum is a deformity of the chest wall in which the sternum and rib cartilage protrude outward, something like the breast of a bird. It is much less common than other chest wall deformities, occurs four times more often in boys than in girls and typically becomes more pronounced during the early growth spurt of adolescence.
What causes pectus carinatum?
No one knows exactly what causes the deformity. It is more common in children who have connective tissue disorders, such as Marfan syndrome, and congenital heart disease. About 25 percent of people affected with pectus carinatum have a family history of chest wall deformities so genetic factors likely play a role in some cases.
What symptoms does it cause?
Pectus carinatum can cause a variety of symptoms, including chest pain, shortness of breath, difficulty exercising and asthma symptoms. Patients may also experience psychological distress and negative body image.
How is pectus carinatum treated?
There are many treatment options for pectus carinatum, including non-surgical bracing and surgery. 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 specific needs.
The Dynamic Compression Brace
Because the chest wall remains relatively flexible in young people until they reach early adulthood wearing a brace over the carinatum deformity can push the chest wall down into a normal shape.
The problem is getting patients to wear braces as directed. To work, braces must be worn for many hours a day and exert enough pressure to reshape the chest. Discomfort and skin breakdown are common side effects of traditional bracing techniques, often causing young patients to abandon treatment.
in 2009, surgeons at Children's Hospital of The King's Daughters began to offer a brace that is easier for children to wear. The Dynamic Compression Brace (DCB) was developed by pediatric surgeons Marcelo Martinez-Ferro and Carlos Fraire in Buenos Aires, Argentina, where pectus carinatum is more common than it is in the United States.
The basic concept behind the Dynamic Compression Brace is to use the precise amount of pressure needed to reshape the chest without causing skin breakdown or so much discomfort that the child will not wear the brace. A special device measures the pounds per square inch that the brace exerts, which is adjusted monthly as the chest slowly assumes a normal shape.
In six years of treatment with 208 patients, Drs. Ferro and Fraire determined that keeping the starting pressures below 2.5 PSI helped avoid the sort of problems that often cause children to give up on treatment. During that time, more than half of their patients completed treatment and of those, 88.4 percent had results that were judged good to excellent in a double blind subjective scale. Average time for wearing the brace was just over 7 hours a day for around 7 months.
The Dynamic Compression Brace is not a good alternative for young people who require more than 7.5 PSI compression to achieve correction.
Read about Dr. Ferro and Fraire’s outcomes with the
Dynamic Compression Brace.
Chest Wall Deformities
In recognition of their critical roles in developing cutting-edge treatment of chest wall deformities such as pectus carinatum and pectus excavatum, the journal Seminars in Pediatric Surgery tapped CHKD Surgeons Dr. Donald Nuss and Dr. Robert Kelly to edit an August, 2008, issue focusing on surgery to correct the anomalies. Nuss and Kelly recruited surgeons to author the articles and edited the entire journal. One of the articles,
The Dynamic compression brace for the correction of pectus carinatum, gives details about the brace developed by Drs. Martinez-Ferro, Fraire and Bernard in Argentina.
Read about a CHKD patient’s
experience with the Dynamic Compression Brace.
Minimally-Invasive Surgery for Pectus Carinatum
The traditional surgical correction of pectus carinatum involves opening the chest and removing portions of the sternum and rib cartilage to reconstruct the chest wall.
Children’s Hospital of The King’s Daughters has recently introduced to the United States a new, minimally invasive method to correct pectus carinatum.
The new procedure is based on the Nuss procedure to correct pectus excavatum, a chest wall deformity in which the chest pushes inward. The Nuss Procedure was developed by pediatric surgeon Donald Nuss at CHKD in the late 1980s and has been performed successfully throughout the world on thousands of patients.
In the new procedure, surgeons introduce a curved bar through a tiny incision on either side of the patient’s chest. These are placed under the muscles of the chest wall and over the sternum, immediately depressing the chest protrusion. The bars are anchored to the ribs with special stabilizers and stay in place for several years so the chest cartilage can harden in the correct position.
Click to see a video on the new surgery.
How can I make an appointment?
Children’s Hospital of The King’s Daughters is located in Norfolk, Virginia, but we work with patients from all over the world on chest wall deformities and can coordinate many aspects of care through your child’s local physician. For more information, please call (757) 668-NUSS.