Fixing Chest Wall Deformities: A Minimally Invasive Option

July 25, 2012 Robert L. Weinsheimer, MD


Pectus excavatum often referred to as either "sunken" or "funnel" chest is the most common congenital chest wall deformity affecting up to one in a thousand children. It results from excessive growth of the cartilage between the ribs and the breast bone (sternum) leading to a sunken (concave) appearance of the chest.

Although present at birth, this usually becomes much more obvious after a child undergoes a growth spurt in their early teens. Pectus excavatum can range from mild to quite severe with the moderate to severe cases involving compression of the heart and lungs. It may not cause any symptoms, however, children with pectus excavatum often report exercise intolerance (shortness of breath or tiring before peers in sports), chest pain, heart problems, and body image difficulties. The last issue deserves some attention as children often are reluctant to discuss how the appearance of their chest affects their self-esteem globally. There is a bias even within the medical community to dismiss the appearance component of pectus excavatum as merely "cosmetic", but I view the surgery to fix this congenital defect as corrective and support the idea that the impact of its appearance should be considered. I have seen patients emotionally transformed in ways that they and their families never expected.

Thanks in great part to the pioneering work of Dr. Donald Nuss (a now retired pediatric surgeon in Virginia), we have a well-proven minimally invasive option to correct pectus excavatum: the Nuss bar procedure. This involves using a curved metal bar tailored to the patient and sliding this into position under the ribs and sternum to correct the defect. A camera is used to safely guide the passage of the bar. The bar is left in place for about 3 years and then a small surgery is required for its removal. I was fortunate enough to learn this procedure from Dr. Nuss along with my adult thoracic colleague, Dr. Farivar. Together we are offering a program to evaluate and treat appropriate patients with this great technique. While this surgery is not necessary for all patients with pectus excavatum, it represents a great option for children and young adults who suffer from any combination of the consequences of this deformity.

(Image source)

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