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Pectus Deformity and Correction – FAQs

Posted by: admin on September 8th, 2012 no responses.

What is a chest wall deformity?

Chest wall deformities are abnormally shaped chest/thorax due to abnormal development of the ribs, cartilage or breast bone. Common types of chest wall deformities are pectus excavatum, pectus carinatum and their combination known as excavatum-carinatum complex.

 

What is pectus excavatum, pectus carinatum and excavatum-carinatum complex?

Pectus excavatum or funnel chest is when the breast bone is depressed so chest appears sunken or hollow   and pectus carinatum or pigeon chest wherein   the breast bone is raised so the chest appears protruded, complex is a combination of both.

 

How common is it?

The funnel chest defect is the more common type and it affects males more often than females occurring in about 1 in 500 to 1000 births.

 

What causes these chest wall deformities?

These are congenital defects where the exact cause is unknown, family history is present in 40 % of cases.

 

What kind of problems does pectus carinatum cause?

Patients get tired sooner than their peers as the defect prevents proper functioning of heart and lungs. It also has psychosocial impact on patient’s self-image and confidence

 

What problems does pectus excavatum cause?

Depending on severity of deformity the heart and the lungs get compressed decreasing their functions.

1. Exercise intolerance and shortness of breath: The parents notice their child cannot keep up with other children in physical activity.

2. Chest pain which may be independent of exercise.

3. Psychosocial effect: Poor body image, decreased self confidence and altered behavior: They avoid activities that involve removing their shirt, such as swimming.

 

What tests are required for a pectus evaluation?

Physical exam is required on every patient followed by chest x-ray and chest CT scan. They assess the severity of the deformity and degree of compression of the heart and lungs. An echocardiogram to evaluate heart function and pulmonary function tests to evaluate lung function is also done.

 

What is the age for treatment?

The younger the better, when the bones are soft and remodel easily with less pain. The ideal scene is a preschool child repaired at 3 years of age and bar removed at 5 years before starting school. Adults beyond 40s have also been repaired.

 

What are the treatment options for pectus excavatum?

For pectus excavatum, surgical repair can be accomplished in one of two ways.

 

Open technique:

The classic open Ravitch technique involves a big incision for repair of the deformity. It involves removal of the abnormal bones and cartilage and regrowth of the bones and cartilage. This causes a weak chest till the time of bone healing which can takes from months to years.

 

Minimally Invasive Repair / NUSS procedure:

The present day technique involves inserting a stainless steel bar through small incisions about 2cm on either side of the chest under video guidance. This is referred to as the minimally invasive pectus repair. The bar is then secured after lifting the chest wall defects into normal position. The bones then remodels into normal shaped chest. As no bones are removed there is no chest wall weakness.

 

What are the treatment options for pectus recurvatum?

For pectus recurvatum, surgical repair can be accomplished using.

 

Reverse Nuss procedure

It involves inserting stainless steel bar through small incisions of 2cm on either side of the chest under video guidance. The bar is then secured after depressing the chest wall protrusion into normal position. The bones then remodels into normal shaped chest. As no bones are removed there is no chest wall weakness.

 

Sandwich technique

It involves inserting stainless steel bar through small incisions of 2cm on either side of the chest under video guidance. The bars then sandwich the deformity on either side allowing the bones to remodel into normal shaped chest. As no bones are removed there is no chest wall weakness.

 

What are the treatment options for pectus excavatum-carinatum complex?

Surgical repair can be done using

 

Sandwich technique / Press mold technique

It involves inserting stainless steel bar through small incisions of 2cm on either side of the chest under video guidance. The bars then sandwich or press mold the deformity on either side allowing the bones to remodel into normal shaped chest. As no bones are removed there is no chest wall weakness.

 

How long will my child be in the hospital after repair?

The average stay for a person who undergoes the minimally invasive pectus repair is approximately seven to ten days. By the time they are discharged from hospital they will be eating, walking, and comfortable. They will need to take some pills for the pain; which is stopped gradually in few days.

 

When will the bars be removed from the chest?

The bars will be inside the chest for about 2 years in children, 3 to 4 years in teenagers and adults. At the end of this period they are removed.

 

What to expect after surgical correction?

Benefits are three folds;

  1. Physiology of heart and lung function improves.
  2. Psychosocial – Improved self confidence.
  3. Cosmetic – Symmetrical chest shape and no big scar of incision

 

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