Skip to main content
SpringerLink
Log in

Pectus Excavatum

  • Chapter
  • First Online:
Pediatric Thoracic Surgery

  • 661 Accesses

Abstract

Pectus excavatum (PE) is the commonest of chest wall anomalies, with a prevalence of 1/300–1000 people. PE represents a cosmetical concern for almost the patients affected, but in most cases, it is a cause of thoracic pain, discomfort, breathing difficulty, and physical exercise limitations. This is due mainly to heart compression by the sternum. Treatment includes conservative methods such as vacuum bell (especially in young patients with mild PE) or surgical approach (thoracoscopic placement of retrosternal bars, Nuss technique). The bar is maintained in situ for 3 years and then removed. This approach should be reserved for centers with large experience, as potential complications are severe.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 99.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 129.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 179.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Kelly RE, Shamberger RC. Chapter 62 - Congenital chest wall deformities. In: Coran AG, editor. Pediatric surgery. 7th ed. Maryland Heights: Mosby; 2012. p. 779–808. ISBN 9780323072557.

    Chapter  Google Scholar 

  2. Meyer L. ZurchirurgischenBehandlung der angeborenenTrichterbrust. BerlKlinWschr. 1911;48:1563–6.

    Google Scholar 

  3. Brochhausen C, Turial S, Müller FK, Schmitt VH, Coerdt W, Wihlm JM, Schier F, Kirkpatrick CJ. Pectus excavatum: history, hypotheses and treatment options. Interact Cardiovasc Thorac Surg. 2012 Jun;14(6):801–6.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Obermeyer RJ, Goretsky MJ. Chest wall deformities in pediatric surgery. Surg Clin North Am. 2012;92(3):669–84.

    Article  PubMed  Google Scholar 

  5. Williams AM, Crabbe DC. Pectus deformities of the anterior chest wall. Paediatr Respir Rev. 2003;4(3):237–42.

    Article  CAS  PubMed  Google Scholar 

  6. Kelly RE, Shamberger RC. Congenital chest wall deformities. In: Coran AG, et al., eds. Pediatric surgery, 7th ed. Elsevier; 2012. pp. 779–808.

    Google Scholar 

  7. Ravitch MM. Repair of pectus excavatum in children under 3 years of age: a twelve-year experience. Ann Thorac Surg. 1977;23:301.

    Article  CAS  PubMed  Google Scholar 

  8. Kelly RE Jr, Quinn A, Varela P, Redlinger RE Jr, Nuss D. Dysmorphology of chest wall deformities: frequency distribution of subtypes of typical pectus excavatum and rare subtypes. ArchBronconeumol. 2013;49(5):196–200.

    Google Scholar 

  9. Cartoski MJ, Nuss D, Goretsky MJ, Proud VK, Croitoru DP, Gustin T, Mitchell K, Vasser E, Kelly RE Jr. Classification of the dysmorphology of pectus excavatum. J Pediatr Surg. 2006;41(9):1573–81.

    Article  PubMed  Google Scholar 

  10. Kelly RE Jr, Quinn A, Varela P, Redlinger RE Jr, Nuss D. Dysmorphology of chest wall deformities: frequency distribution of subtypes of typical pectus excavatum and rare subtypes. Arch Bronconeumol. 2013;49(5):196–200.

    Article  PubMed  Google Scholar 

  11. Salamanca A, Girona A, Padilla MC, Sabatel RM, Gonzales-Gomez F. Prenatal diagnosis of pectus excavatum and its relation to Down’s syndrome. Ultrasound Obstet Gynecol. 1992;2(6):446–7.

    Article  CAS  PubMed  Google Scholar 

  12. Çetin C, Büyükkurt S, Sucu M, Özsürmeli M, Demir C. Prenatal diagnosis of pectus excavatum.Turk J Obstet Gynecol. Sep. 2016;13(3):158–60.

    Google Scholar 

  13. Waters P, Welch K, Micheli LJ, Shamberger R, Hall JE. Scoliosis in children with pectus excavatum and pectus carinatum. J Pediatr Orthop. 1989;9(5):551–6.

    Article  CAS  PubMed  Google Scholar 

  14. Kotzot D, Schwabegger AH. Etiology of chest wall deformities - a genetic review for the treating physician. J Pediatr Surg. 2009;44(10):2004–11.

    Article  PubMed  Google Scholar 

  15. Feng J, Hu T, Liu W, Zhang S, Tang Y, Chen R, Jiang X, Wei F. The biomechanical, morphologic, and histochemical properties of the costal cartilages in children with pectus excavatum. J Pediatr Surg. 2001;36(12):1770–6.

    Article  CAS  PubMed  Google Scholar 

  16. Raggi P, Callister TQ, Lippolis NJ, et al. Is mitral valve prolapse due to cardiac entrapment in the chest cavity? A CT view. Chest. 2000;117:636–42.

    Article  CAS  PubMed  Google Scholar 

  17. Fonkalsrud EW. Management of pectus chest deformities in female patients. Am J Surg. 2004;187(2):192–7.

    Article  PubMed  Google Scholar 

  18. Sujka JA. St Peter SD. Quantification of pectus excavatum: Anatomic indices. Semin Pediatr Surg. 2018;27(3):122–6.

    Article  PubMed  Google Scholar 

  19. Haller JA Jr, Kramer SS, Lietman SA. Use of CT scans in selection of patients for pectus excavatum surgery: a preliminary report. J Pediatr Surg. 1987;22(10):904–6.

    Article  PubMed  Google Scholar 

  20. Khanna G, Jaju A, Don S, Keys T, Hildebolt CF. Comparison of Haller index values calculated with chest radiographs versus CT for pectus excavatum evaluation. Pediatr Radiol. 2010;40(11):1763–7.

    Article  PubMed  Google Scholar 

  21. Torre M, Rapuzzi G, Jasonni V, Varela P. In: Paulo Cardoso, editor. Chest wall deformities: an overview on classification and surgical options, topics in thoracic surgery. London: IntechOpen; 2012. https://doi.org/10.5772/25950.

    Chapter  Google Scholar 

  22. St Peter SD, Juang D, Garely CL, et al. A novel measure for pectus excavatum: the correction index. J Pediatr Surg. 2011; 46(12):326–330. The correction index: setting the standard for recommending operative repair of pectus excavatum. Ann Thorac Surg. 2014;97(4):1176–9.

    Google Scholar 

  23. Kelly RE Jr, Shamberger RC, Mellins RB, Mitchell KK, Lawson ML, Oldham K, Azizkhan RG, Hebra AV, Nuss D, Goretsky MJ, Sharp RJ, Holcomb GW 3rd, Shim WK, Megison SM, Moss RL, Fecteau AH, Colombani PM, Bagley TC, Moskowitz AB. Prospective multicenter study of surgical correction of pectus excavatum: design, perioperative complications, pain, and baseline pulmonary function facilitated by internet-based data collection. J Am Coll Surg. 2007;205(2):205–16.

    Article  PubMed  Google Scholar 

  24. Obermeyer RJ, Gaffar S, Kelly RE, Kuhn MA, Frantz FW, McGuire MM, Paulson JF, Kelly CS. Selective versus routine patch metal allergy testing to select bar material for the Nuss procedure in 932 patients over 10 years. J Pediatr Surg. 2018;53(2):260–4.

    Article  PubMed  Google Scholar 

  25. Nuss D, Obermeyer RJ, Kelly RE. Pectus excavatum from a pediatric surgeon's perspective. Ann Cardiothorac Surg. 2016;5(5):493–500.

    Article  PubMed  PubMed Central  Google Scholar 

  26. Nuss D, Obermeyer RJ, Kelly RE. Nuss bar procedure: past, present and future. Ann Cardiothorac Surg. 2016;5(5):422–33.

    Article  PubMed  PubMed Central  Google Scholar 

  27. Nuss D, Kelly RE Jr. Indications and technique of Nuss procedure for pectus excavatum. Thorac Surg Clin. 2010;20(4):583–97.

    Article  PubMed  Google Scholar 

  28. Colombani PM. Preoperative assessment of chest wall deformities. Semin Thorac Cardiovasc Surg. 2009;21:58–63.

    Article  PubMed  Google Scholar 

  29. Frantz FW. Indications and guidelines for pectus excavatum repair. Curr Opin Pediatr. 2011;(4):486–91.

    Google Scholar 

  30. Kelly RE, Goretsky MJ, Obermeyer R, Kuhn MA, Redlinger R, Haney TS, Moskowitz A, Nuss D. Twenty-one years of experience with minimally invasive repair of pectus excavatum by the Nuss procedure in 1215 patients. Ann Surg. 2010;252(6):1072–81.

    Article  PubMed  Google Scholar 

  31. Haecker FM, Sesia S. Non-surgical treatment of pectus excavatum. J Vis Surg. 2016;2:63.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Haecker FM, Mayr J. The vacuum bell for treatment of pectus excavatum: an alternative to surgical correction? Eur J Cardiothorac Surg. 2006;29:557–61.

    Article  PubMed  Google Scholar 

  33. Haecker FM. The vacuum bell for treatment of pectus excavatum: an effective tool for conservative therapy. J Clin Anal Med. 2011;2:1–4.

    Google Scholar 

  34. Haecker FM. The vacuum bell for conservative treatment of pectus excavatum: the Basle experience. Pediatr Surg Int. 2011;27:623–7.

    Article  PubMed  Google Scholar 

  35. Obermeyer RJ, Cohen NS, Kelly RE Jr, Ann Kuhn M, Frantz FW, McGuire MM, Paulson JF. Nonoperative management of pectus excavatum with vacuum bell therapy: a single center study. J Pediatr Surg. 2018;53(6):1221–5.

    Article  PubMed  Google Scholar 

  36. Haller JA Jr, Colombani PM, Humphries CT, Azizkhan RG, Loughlin GM. Chest wall constriction after too extensive and too early operations for pectus excavatum. Ann Thorac Surg. 1996;61(6):1618–24.

    Article  PubMed  Google Scholar 

  37. Kelly RE Jr. Pectus excavatum: historical background, clinical picture, preoperative evaluation and criteria for operation. Semin Pediatr Surg. 2008;17(3):181–93.

    Article  PubMed  Google Scholar 

  38. Brochhausen C, Turial S, Müller FK, Schmitt VH, Coerdt W, Wihlm JM, Schier F, Kirkpatrick CJ. Pectus excavatum: history, hypotheses and treatment options. Interact Cardiovasc Thorac Surg. 2012;14(6):801–6.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Ravitch MM. The operative treatment of pectus excavatum; October 1948.

    Google Scholar 

  40. Nuss D, Kelly RE Jr. Minimally invasive surgical correction of chest wall deformities in children (Nuss procedure). Adv Pediatr Infect Dis. 2008;55:395–410.

    Google Scholar 

  41. Kelly RE, Nuss D. Pectus excavatum. In: Pediatric thoracic surgery, vol. 43. Parikh DH, et al., eds. London: Springer; 2009. pp. 535–45. https://doi.org/10.1007/b136543_43.

  42. Kelly RE Jr, Mellins RB, Shamberger RC, Mitchell KK, Lawson ML, Oldham KT, Azizkhan RG, Hebra AV, Nuss D, Goretsky MJ, Sharp RJ, Holcomb GW 3rd, Shim WK, Megison SM, Moss RL, Fecteau AH, Colombani PM, Cooper D, Bagley T, Quinn A, Moskowitz AB, Paulson JF. Multicenter study of pectus excavatum, final report: complications, static/exercise pulmonary function, and anatomic outcomes. J Am Coll Surg. 2013;217(6):1080–9.

    Article  PubMed  Google Scholar 

  43. Kanagaratman A, Phan S, Tchantchaleishvilli V, Phan K. Ravitch versus Nuss procedure for pectus excavatum: systematic review and meta-analysis. Ann Cardiothorac Surg. 2016;5(5):409–21.

    Article  Google Scholar 

  44. Fonkalsrud EW, Dunn JC, Atkinson JB. Repair of pectus excavatum deformities: 30 years of experience with 375 patients. Ann Surg. 2000;231(3):443–8.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  45. Park HJ, Lee SY, Lee CS. Complications associated with the Nuss procedure: analysis of risk factors and suggested measures for prevention of complications. J Pediatr Surg. 2004;39(3):391–5.

    Article  PubMed  Google Scholar 

  46. Moss LR, Albanese CT, Reynolds M. Major complications after minimally invasive repair of pectus excavatum: case reports. J Pediatr Surg. 2001;36(1):155–8.

    Article  CAS  PubMed  Google Scholar 

  47. Leonhardt J, et al. Complications of the minimally invasive repair of pectus excavatum. J Pediatr Surgery 2005;40:E7-E9.

    Google Scholar 

  48. Hebra A, Kelly RE, Ferro MM, Yüksel M, Campos JRM, Nuss D. Life-threatening complications and mortality of minimally invasive pectus surgery. J Pediatr Surg. 2018;53(4):728–32.

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Unit of Pediatric Thoracic and Airway Surgery, IRCCS Istituto Giannina Gaslin, Genova, Italy

    Michele Torre

  2. Pediatric Surgery, IRCCS Giannina Gaslini Genoa, University of Genoa, DINOGMI, Genoa, Italy

    Federico Palo

Authors
  1. Michele Torre
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Federico Palo
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Michele Torre .

Editor information

Editors and Affiliations

  1. Department of Pediatric Surgery, IRCCS Giannina Gaslini Institute, Genova, Italy

    Girolamo Mattioli

  2. IRCCS Istituto Giannina Gaslini, Genova, Italy

    Paolo Petralia

  3. Unit of Pediatric Thoracic and Airway Surgery, IRCCS Istituto Giannina Gaslin, Genova, Italy

    Michele Torre

Rights and permissions

Reprints and permissions

Copyright information

© 2021 Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Torre, M., Palo, F. (2021). Pectus Excavatum. In: Mattioli, G., Petralia, P., Torre, M. (eds) Pediatric Thoracic Surgery. Springer, Cham. https://doi.org/10.1007/978-3-030-74668-1_8

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-74668-1_8

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-74667-4

  • Online ISBN: 978-3-030-74668-1

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation