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What is pectus excavatum?

 

If your child develops a sunken chest — referred to as pectus excavatum — chances are that another family member has had the congenital condition too. While pectus excavatum causes are unknown, the condition tends to run in families; 25 percent of patients discover a family history of others with “funnel chest” (also known as caved-in chest).

The condition is the most common deformity in children’s chest walls and can become visible anytime from infancy through puberty. Pectus excavatum occurs in about 1 in 1,000 children and is 4 times more common in males than females. It occurs when several ribs and the sternum (breastbone) don’t grow normally, causing the sternum to be pressed inward and resulting in a depression that is visible when looking at your child’s chest. The depression can range in size and depth, being deeper on one side, causing the breastbone to be curved and, in severe cases, pushing the sternum to nearly touch the spine. Pectus excavatum can cause functional impairment as well as psychosocial problems.

There is a slight correlation between pectus excavatum and scoliosis, although one doesn’t necessarily cause another.

What are the symptoms of pectus excavatum?

Symptoms such as shortness of breath, chest pain or exercise intolerance may or may not occur. Body image issues are also common. ​

Kids with pectus excavatum should be encouraged to live active lifestyles without any restrictions.

Can I participate in sports if I have pectus excavatum?

Yes! People who have pectus excavatum should continue participating in all activities they find enjoyable. Some symptoms may be exacerbated with physical activity but the activity itself does not pose a health risk. Pay attention to activities that seem to cause problems and ask your pectus professional if there is any relation.

What are the treatment options?

For mild cases without associated symptoms and young children, observation will likely be recommended. Mild pectus excavatum often can be improved with exercises to increase upper-body strength and improve posture.

Most kids aren't bothered by having a concave chest until they begin their growth spurt. Adolescences with a severe case of pectus excavatum and associated symptoms may be a candidate for surgical repair with the minimally invasive repair of pectus excavatum.

To determine the severity of the defect a chest CT (CAT scan) of your child's chest to measure the indented chest depression may be recommended to determine surgical candidacy. The CT scan is not painful and simply requires your child to lie still for about 5-10 minutes while a series of pictures are taken.

Additional testing (such as exercise stress test, pulmonary function tests or an echocardiogram) may be required depending on the insurance company for approval of surgery. We recommend checking with your insurance company.

Pectus excavatum surgery

Doctors began using open surgery to correct the condition in the early 1900s. Eighty years later, Donald Nuss, MD, a Norfolk, Va., doctor, devised an approach that was less invasive. Since then, the general surgeons at Children’s Mercy have modified the Nuss procedure.

The surgeon inserts a steel bar that has been curved to fit under the concave sternum and around the front of the chest. The bar helps reshape the chest as the child grows.

After about three years, the bar is removed in a same-day procedure. This pectus excavatum treatment is highly effective. Less than 1 percent of children will develop the condition again.

Using cryoablation to reduce pain after surgery

Pectus Excavatum Surgery at Children's Mercy

Cryoablation is a newer modality of pain management for patients undergoing bar placement to repair pectus excavatum repair that dramatically reduces pain after surgery. The decision to use cryoablation was based on extensively investigating patient outcomes which revealed that cryoablation was safe and effective to improve pain control and shortened the hospital stay. In the operating room, the surgeon will freeze 4 intercostal nerves on each side prior to placing the bar. This will temporarily decrease pain transmission through these nerves. The full effect may take 12-24 hours for optimal pain control. This does not eliminate the pain completely. The cryoablation will last between 2-3 months. Patients may experience some skin numbness to chest wall. The numbness should resolve within 3-6 months when the nerve regenerates.

The patients will go home with short term use of oral pain medications to continue during their recovery. When cryoablation works well, most patients can go home with in a day or two after surgery. Some may be able to be discharged the day of surgery.

After pectus surgery

Your child will not need any stitches removed because doctors will have closed the incisions using dissolving stitches beneath the skin. Steri strips will be in place and fall off on their own in ~ 2 weeks. The incisions will be pink and gradually fade over the next year. Recommend keeping sunscreen on the scars for improved healing.

Follow-up appointments

2 weeks and 3 months following surgery and then annually until it is time for removed.

Limiting your child’s activity

Depending on how you child is recovering following surgery we recommend slow return to activities. There are no weight restrictions regarding heavy lifting but recommend taking it slow and do what is comfortable.

  • No strenuous physical activity for 2 weeks following surgery

  • May return to normal activity as tolerated after 2 weeks

  • No slouching or slumping. Good posture is strongly encouraged.

Returning to school

Usually, children need to be home for about 1 week after surgery. Your child can return to school when his or her energy level and pain control permits.

While the bar is in place

  • No MRI examinations of the chest and abdomen. CT scans are acceptable.

  • If defibrillation is needed, paddle placement needs to be anterior/posterior (front and back).

  • CPR CAN BE PERFORMED. May require more exertional external force.

    • Medic alert bracelet recommended. Inscription should state “surgical steel bar in chest”. You can find these at identifyyourself.com.You can find these at identifyyourself.com.

What to do if you have concerns

Contact the pectus team at (816) 234-3199 with the following concerns:

  • The incision becomes red, swollen, very painful or begins draining or a rash develops.

  • You think the bar has become dislodged (the chest changes shape or your child has been hit forcefully in the chest).

  • New pain not responsive to over-the-counter pain medications.

Stories

Inside Pediatrics: Jacob's story

Revolutionary cryoablation procedures pioneered at Children’s Mercy allow Jacob to recover with almost no discomfort from a chest repair that used to cause months of pain.

Pectus excavatum: Sophie's story

When Sophie Penland needed surgery to correct pectus excavatum, a chest wall deformity, her mom brought her to the experts at Children’s Mercy. Now the teenager is dancing to her heart’s content.

Meet Sophie
Children's Mercy patient Sophie receives care at the Center for Pectus Excavatum and Carinatum.
Children's Mercy is an American College of Surgeons Verified Center

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Read about how to prepare your child for scheduled surgery, what to expect when you arrive, and resources available while you’re here.

Pediatric anesthesia at Children's Mercy

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We administer anesthesia for more than 27,000 kids per year—that’s 74 per day—so our team is experienced at finding just-right doses of medication for kids of all sizes.