Pectus excavatum (PE), also known as “sunken chest” or “funnel chest,” is a birth defect characterized by a sunken sternum, or breastbone. It is fairly common, affecting one in every 1,000 kids. For every girl affected by PE, four boys will suffer with it. Shortness of breath with exertion and chest pain are the two most common problems caused by the deformity and can be debilitating. Fortunately, the minimally invasive “Nuss” procedure alleviates these problems with minimal scarring, giving patients more self-confidence and an improved quality of life.
The deformity is caused by excessive lengthening of the individual cartilages that connect each rib to the sternum causing the sternum to buckle inward towards the spine. This buckling can compress or displace the heart and lungs. Despite the compression of the heart and the lungs by the depressed breastbone, PE is not dangerous and does not affect life expectancy. In most patients, the deformity is evident at birth.
Pre-teens do not generally experience symptoms nor are they too affected by the physical appearance of the deformity. However, many patients experience a significant worsening of the deformity during their adolescent growth spurt, resulting in either shortness of breath during exertion or chest pain. If these teens have active lifestyles, especially if they are involved with sports, the onset of these symptoms can greatly impair their performance and contribute to a significant reduction in their quality of life.
Making matters worse, teens at this age are at a vulnerable point in their lives psychosocially, and body image becomes disproportionately important to them. The worsening of the deformity during adolescence can also take a psychological toll. This, too, has potentially significant and lasting effects for many patients.
Compared with the traditional open “Ravitch” repair, the Nuss procedure is far less invasive, requiring a single small incision under each armpit. Through a series of maneuvers, a customized curved stainless steel bar is positioned behind the sternum but on top of ribs of the front and sides of the chest wall, using them as a base of support. The bar pushes the sternum to its proper position as it sits on the ribs and entirely under the skin, soft tissues and pectoralis muscles.
The improvement is immediate, with the sternum and chest wall forced into a normal shape for the first time in the patient’s life. The heart can shift back to its proper position, the lungs can fully expand, and these organs perform better within the normally shaped chest – all before the patient leaves the operating room. After a few weeks of convalescence patients enjoy significant improvement in breathing, discomfort, stamina and appearance.
The patient spends four to five days in the hospital and can usually return to work or school within 10 days. Most are able to resume normal activities in six to eight weeks – including contact sports – far sooner than with the traditional open Ravitch repair.
The bar is left in place for three years while the chest remodels itself to the normal contour. The bar is then removed during an outpatient procedure with the chest maintaining its proper shape.
Teenagers and young adults suffering with PE no longer need be sidelined by debilitating shortness of breath with exertion. And those patients who live with the social awkwardness caused by their chest deformity need not suffer any longer. The Nuss procedure is the cure for this common birth deformity that gets patients back to physical activity far sooner than traditional open operations.
Mark Saxton is a pediatric surgeon with the Wesley Pediatric Surgery Clinic.